Individual
IVAN RAFAEL MATOS DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E 28TH ST, MINNEAPOLIS, MN 55407-3723
(612) 863-3200
(612) 863-2837
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
61825
MN
2084V0102X
Vascular Neurology Physician
61825
MN
2084V0102X
Vascular Neurology Physician
ME156611
FL
Other
Enumeration date
07/30/2012
Last updated
01/30/2025
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