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1235166737

NPI Code Detail

MEDICARE: DR. DEANNA JO DIEBOLD M.D.

MEDICARE: DR. DEANNA JO DIEBOLD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	37330	MN
2	207RP1001X	Pulmonary Disease Physician	37330	MN
3	207R00000X	Internal Medicine Physician	37330	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	114004	OTHER	MN	UCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	510K9DI	OTHER	MN	BCBS
6	04-07870	OTHER	MN	MEDICA CHOICE
7	HP19625	OTHER	MN	HEALTHPARTNERS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	887653	OTHER	MN	ARAZ
10	04-00123	OTHER	MN	MEDICA PRIMARY

General Provider Information

NPI Number	:	1235166737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEANNA JO DIEBOLD M.D.

Provider Business Mailing Address
First Line	:	3366 OAKDALE AVE N STE 401
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2986
Country	:	US
Telephone Number	:	763-520-2940
Fax Number	:	763-520-2943

Provider Business Practice Location Address
First Line	:	3366 OAKDALE AVE N STE 401
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2986
Country	:	US
Telephone Number	:	635-202-9407
Fax Number	:	763-520-2943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/30/2021

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Directions to “ DR. DEANNA JO DIEBOLD M.D.” Practice Location

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