IndividualActive
Jason Dieterle, DO
NPI 1376730069 · Sports Medicine (Orthopaedic Surgery) Physician · Oak Park Heights, MN
Provider details
- NPI number
- 1376730069
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) PhysicianAllopathic & Osteopathic Physicians
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- License
- 51694 (MN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
5715 Memorial Ave N
Oak Park Heights, MN 55082-1093
Phone: (651) 439-8807
Fax: (651) 439-0232
Approximate (ZIP-level) locationGet directions
Mailing address
3500 American Blvd W Ste 300
Bloomington, MN 55431-4442
Registry dates
- Enumerated
- 2007-09-26
- Last updated
- 2024-09-04
- Certified
- 2024-09-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.