Organization
AESTHETIC-RECONSTRUCTIVE PLASTIC SURGERY, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J DIEM D.D.S, M.D. (DR/OWNER)
(763) 780-8927
Entity
Organization
Contact information
Practice address
500 OSBORNE RD NE, UNITY PROFESSIONAL BLDG SUITE 350, FRIDLEY, MN 55432-2765
(763) 780-8927
Mailing address
500 OSBORNE RD NE, UNITY PROFESSIONAL BLDG SUITE 350, FRIDLEY, MN 55432-2765
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
24664
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03507AE
BCBS ID
MN
01
—
C00776
MEDICARE GROUP ID
MN
Enumeration date
08/28/2007
Last updated
08/28/2007
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