Individual provider · Type 1 NPI
Tore Detlie, MD
Diagnostic Radiology Physician · Maplewood, MN
NPI number
1841240686
Active
Practice location
918 Demont Ave E
Maplewood, MN 55109-1953
Fax (612) 294-4903
Mailing address
11995 Singletree Ln, Suite 500
Eden Prairie, MN 55344-5347
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Diagnostic Radiology Physician Primary | 2085R0202X | 29546 (MN) |
| Diagnostic Radiology Physician | 2085R0202X | 15435 (NH) |
Diagnostic Radiology Physician: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
About NPI 1841240686
Tore Detlie, MD's National Provider Identifier is 1841240686, issued on May 11, 2006. The primary taxonomy on file is Diagnostic Radiology Physician (2085R0202X), and the practice location is in Maplewood, MN. The record was last updated on Jul 19, 2012.