Aesthetic-Reconstructive Plastic Surgery, LTD

Primary specialty

SpecialistTaxonomy code 174400000X

License

24664 Issued in MN

Legal business name

AESTHETIC-RECONSTRUCTIVE PLASTIC SURGERY, LTD

Practice address

500 Osborne Rd NE
Unity Professional BLDG Suite 350
Fridley, MN 55432-2765

Phone

(763) 780-8927

NPI assigned

Aug 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas J Diem, D.D.S, M.D.

Title

Dr/Owner

Phone

(763) 780-8927

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1801080353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 OSBORNE RD NE",
            "address_2": "UNITY PROFESSIONAL BLDG SUITE 350",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 OSBORNE RD NE",
            "address_2": "UNITY PROFESSIONAL BLDG SUITE 350",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322765",
            "telephone_number": "763-780-8927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC-RECONSTRUCTIVE PLASTIC SURGERY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-28",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "DIEM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DR/OWNER",
        "authorized_official_telephone_number": "763-780-8927",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S, M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MN",
            "license": "24664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "C00776",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "03507AE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fridley, MN
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.