Individual
DR. DEANNA JO DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3366 OAKDALE AVE N STE 401, ROBBINSDALE, MN 55422-2986
(635) 202-9407
(763) 520-2943
Mailing address
3366 OAKDALE AVE N STE 401, ROBBINSDALE, MN 55422-2986
(763) 520-2940
(763) 520-2943
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37330
MN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
37330
MN
207RP1001X
Pulmonary Disease Physician
37330
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147135
—
MT
01
—
04-00123
MEDICA PRIMARY
MN
01
—
04-07870
MEDICA CHOICE
MN
05
—
0598920
—
IA
01
—
114004
UCARE
MN
05
—
315812800
—
MN
05
—
32297100
—
WI
01
—
510K9DI
BCBS
MN
01
—
887653
ARAZ
MN
01
—
HP19625
HEALTHPARTNERS
MN
Enumeration date
06/28/2006
Last updated
07/30/2021
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