Individual
DR. DANIEL J DIEKEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
41 DONALD B DEAN DR, SOUTH PORTLAND, ME 04106-3252
(207) 661-7901
Mailing address
41 DONALD B DEAN DR, SOUTH PORTLAND, ME 04106-3252
(207) 661-7901
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
28731
IA
207RI0200X
Infectious Disease Physician
28731
IA
207RI0200X
Infectious Disease Physician
Primary
MD14027
ME
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
28731
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0098376
—
IA
01
—
47989
WELLMARK BCBS
IA
Enumeration date
12/09/2005
Last updated
09/12/2022
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