Individual
JASON PAUL DIETERLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5715 MEMORIAL AVE N, OAK PARK HEIGHTS, MN 55082-1093
(651) 439-8807
(651) 439-0232
Mailing address
3500 AMERICAN BLVD W STE 300, BLOOMINGTON, MN 55431-4442
(952) 512-5600
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
51694
MN
207X00000X
Orthopaedic Surgery Physician
52724-21
WI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
51694
MN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
52724-21
WI
Other
Enumeration date
09/26/2007
Last updated
09/04/2024
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