Individual
MARY ELIZABETH IMDIEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
515 DELAWARE ST SE, CLEFT PALATE CLINIC - 6TH FLOOR MOOS TOWER, MINNEAPOLIS, MN 55455-0357
(612) 625-2495
Mailing address
515 DELAWARE ST SE, CLEFT PALATE CLINIC - 6TH FLOOR MOOS TOWER, MINNEAPOLIS, MN 55455-0357
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
D11276
MN
Other
Enumeration date
11/14/2006
Last updated
08/14/2007
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