Individual
TREVOR JOHN DIERCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
325 11TH AVE, TWO HARBORS, MN 55616-1300
(218) 249-5555
Mailing address
325 11TH AVE, TWO HARBORS, MN 55616-1300
(218) 249-5555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
72290
MN
207Q00000X
Family Medicine Physician
74574
WI
207Q00000X
Family Medicine Physician
7908
WI
Other
Enumeration date
04/08/2019
Last updated
08/08/2022
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