Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | LP1219 | MN |
NPI | 1093874281 |
---|---|
Provider Name | Thomas Leo Diana |
First Address | Winona, MN 55987-3478 |
Second Address | Winona, MN 55987-3478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 22/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126921 | UCARE (01) | MN |
200048200 | (05) | MN |
731291041000 | PREFERRED ONE (01) | MN |
78G63DI | BCBS-MN (01) | MN |
HP41036 | HEALTHPARTNERS (01) | MN |