Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 48446 | MN |
NPI | 1023050978 |
---|---|
Provider Name | Mark E Dietrich |
First Address | Omaha, NE 68198-1080 |
Second Address | Omaha, NE 68198-1080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 09/11/2012 |