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Individual

LARRY A. ZIESKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2211 PARK AVE, MINNEAPOLIS, MN 55404-3711
(612) 871-1144
(612) 871-2012
Mailing address
2211 PARK AVE, MINNEAPOLIS, MN 55404-3711
(612) 871-1144
(612) 871-2012

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
37062
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1000010
MEDICA PRIMARY
MN
01
1000133
MEDICA CHOICE
MN
01
1016754
PREFERREDONE
MN
01
32466700
MEDICAID - WISCONSIN
WI
05
639817100
MN
01
768882
AMERICA'S PPO
MN
01
76D32ZI
BLUE SHIELD
MN
Enumeration date
08/11/2005
Last updated
05/29/2013
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