Basic Information
| Provider Information | |||||||||
| NPI: | 1346218823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIEN | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025309 | ||||||||
| FaxNumber: | 6512226786 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 E NICOLLET BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553376749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528927190 | ||||||||
| FaxNumber: | 9528927956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 12/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 32130 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 110999 | 01 | MN | UCARE MN | OTHER | HP13164 | 01 | MN | HEALTHPARTNERS | OTHER | 3600788 | 01 | MN | MEDICA | OTHER | 31682200 | 05 | WI | MEDICAID | 8T408DI | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER | 0104004 | 01 | MN | PREFERRED ONE | OTHER | 523590100 | 05 | MN | MEDICAID | 23252 | 01 | MN | AMERICA'S PPO | OTHER |