Active NPI
Larry A. Zieske, M.D.
- Otolaryngology Physician
- Minneapolis, MN
National Provider Identifier
1841292646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 37062
- Practice address
- 2211 Park Ave
Minneapolis, MN 55404-3711 - Phone
- (612) 871-1144
- Fax
- (612) 871-2012
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 37062 | MN | Primary |
Addresses
Primary practice location
2211 Park Ave
Minneapolis, MN 55404-3711
Mailing address
2211 Park Ave
Minneapolis, MN 55404-3711
Phone (612) 871-1144
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 76D32ZI | Other | MN | BLUE SHIELD |
| 1000010 | Other | MN | MEDICA PRIMARY |
| 1000133 | Other | MN | MEDICA CHOICE |
| 32466700 | Other | WI | MEDICAID - WISCONSIN |
| 639817100 | Medicaid | MN | |
| 1016754 | Other | MN | PREFERREDONE |
| 768882 | Other | MN | AMERICA'S PPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37062 | MN | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369785600000",
"number": "1841292646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2211 PARK AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554043711",
"telephone_number": "612-871-1144",
"fax_number": "612-871-2012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 PARK AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554043711",
"telephone_number": "612-871-1144",
"fax_number": "612-871-2012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIESKE",
"first_name": "LARRY",
"middle_name": "A.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-11",
"last_updated": "2013-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MN",
"license": "37062",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "76D32ZI",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA PRIMARY",
"identifier": "1000010",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA CHOICE",
"identifier": "1000133",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID - WISCONSIN",
"identifier": "32466700",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "639817100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "1016754",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "768882",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.