Individual
MR. THOMAS J DIEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
500 OSBORNE RD NE, UNITY PROFESSIONAL BLDG SUITE 350, FRIDLEY, MN 55432-2765
(763) 780-8927
(763) 780-1286
Mailing address
12010 53RD AVE N, PLYMOUTH, MN 55442-1834
(763) 557-1353
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
24664
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03507AE
BCBS ID
MN
01
—
1305105
MEDICA ID
MN
Enumeration date
10/12/2006
Last updated
07/08/2007
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