MEDICARE: DR. DENNIS BROOK DISCHINGER 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	207Q00000X	Family Medicine Physician	43636	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP40247	OTHER	MN	HEALTH PARTNERS
2	01-19756	OTHER	MN	MEDICA
3	576A2DI	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1326177726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS BROOK DISCHINGER M.D.

Provider Business Mailing Address
First Line	:	2600 29TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1537
Country	:	US
Telephone Number	:	612-724-4544
Fax Number	:	612-371-0289

Provider Business Practice Location Address
First Line	:	425 20TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-4400
Country	:	US
Telephone Number	:	612-332-4973
Fax Number	:	612-371-0289

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

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	07/08/2007

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