1972686442 NPI number — DR. DIANE J. MADLON-KAY MD

Table of content: DR. DIANE J. MADLON-KAY MD (NPI 1972686442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972686442 NPI number — DR. DIANE J. MADLON-KAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADLON-KAY
Provider First Name:
DIANE
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972686442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 EAST 28TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55407-1453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-333-0770
Provider Business Mailing Address Fax Number:
612-333-1986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 EAST 28TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-333-0770
Provider Business Practice Location Address Fax Number:
612-333-1986
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  31314 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-21285 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2380613 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP10946 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 506K0MA . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: A054 . This is a "TRIWEST/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1018848 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31360100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-21285 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0596247 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105929 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".




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