Individual
CARMEN N DIVERTIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 PARK AVE (P7), MINNEAPOLIS, MN 55415-1829
(612) 873-2300
(612) 904-4261
Mailing address
701 PARK AVE (P7), MINNEAPOLIS, MN 55415-1829
(612) 873-2300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36139
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006363100
—
MN
Enumeration date
05/19/2006
Last updated
10/19/2012
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