IVAN RAFAEL MATOS DIAZ (NPI# 1972859767) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972859767 |
| Entity Type | Individual |
| Full Name | IVAN RAFAEL MATOS DIAZ |
| Credential | M.D. |
| Practice Address |
701 Park Ave Minneapolis MN 55415-1623 |
| Practice Telephone | 9172939476 |
| Mailing Telephone | 6128732939 |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2018-04-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
284799 | NY | Allopathic & Osteopathic Physicians |
| Y | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
61825 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
701 PARK AVE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55415-1623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750387734 | David C Templeman | Orthopaedic Surgery | 701 Park Ave, Department of Orthopedics, Minneapolis, MN 55415-1623 | 2005-06-23 |
| 1164029336 | James Wayne Fisher | Psychologist | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-10-01 |
| 1396351482 | Emily Ann Beck | Physical Therapist | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-09-23 |
| 1932714524 | Manju Elizabeth Alexander | Psychologist | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-09-10 |
| 1043838675 | Ayan Hashi | Student in an Organized Health Care Education/Training Program | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-07-09 |
| 1366068561 | Roberto Emilio Fu Carrasco | Student in an Organized Health Care Education/Training Program | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-06-23 |
| 1104448810 | Michael Berryman | Student in an Organized Health Care Education/Training Program | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-05-15 |
| 1811519192 | Viktoriya A. Ishchuk | Student in an Organized Health Care Education/Training Program | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-05-10 |
| 1861014235 | Abdurahman Salah Ibrahim | Student in an Organized Health Care Education/Training Program | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-05-08 |
| 1962024430 | Timothy Baerg | Student in an Organized Health Care Education/Training Program | 701 Park Ave, Minneapolis, MN 55415-1623 | 2020-05-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114547643 | Kevin Reininger | Pharmacist | 730 S 8th St., Pharmacy Department, Minneapolis, MN 55415 | 2020-04-24 |
| 1124674551 | Andrew Michael Baker | Pathology | Hennepin County Medical Examiner, 530 Chicago Ave, Minneapolis, MN 55415 | 2019-08-12 |
| 1598326951 | Monazza Iqbal Chaudhry | Student in an Organized Health Care Education/Training Program | Hennepin County Medical Center 701 Park Avenue, Minneapolis, MN 55415 | 2019-06-26 |
| 1760947196 | Brandon Haas | Pharmacist | 701 Park Ave Rll, Minneapolis, MN 55415 | 2019-02-11 |
| 1710474192 | Andrea Kramer | Student in an Organized Health Care Education/Training Program | Hennepin County Medical Center Emergency Medicine, 701 Park Avenue, Minneapolis, MN 55415 | 2018-04-20 |
| 1750888640 | Alexandra Rose Coward | Student in an Organized Health Care Education/Training Program | Hennepin County Medical Center - General Surgery, 701 Park Avenue, Minneapolis, MN 55415 | 2018-04-09 |
| 1194235861 | Gretchen Jane Vanderlinden-wang | Social Worker | Hennepin County Medical Center Adult Psychiatry Clinic, 701 Park Avenue, Shapiro Building, Suite S1.110, Minneapolis, MN 55415 | 2017-10-06 |
| 1720501117 | Dominique Lacha Jones | Advanced Practice Midwife | 716 South 7th Street, Purple Building Level 5, Minneapolis, MN 55415 | 2017-07-18 |
| 1669905618 | Joseph Douglas Steffens | Internal Medicine | 701 Park Avenue, Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, MN 55415 | 2017-04-06 |
| 1215469689 | Michael Reitz | Student in an Organized Health Care Education/Training Program | 701 Park Avenue, B5.118, Minneapolis, MN 55415 | 2017-04-03 |
| Find all providers in zip 55415 | ||||
| Taxonomy Code | 2084V0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Vascular Neurology |
| Vascular Neurology is a subspecialty in the evaluation, prevention, treatment and recovery from vascular diseases of the nervous system. This subspecialty includes the diagnosis and treatment of vascular events of arterial or venous origin from a large number of causes that affect the brain or spinal cord such as ischemic stroke, intracranial hemorrhage, spinal cord ischemia and spinal cord hemorrhage. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477725133 | Ellie Eun Ju Choi | Psychiatry & Neurology | 401 Phalen Blvd, Mail Stop 41104c, Saint Paul, MN 55130-5302 | 2008-04-01 |
| City | MINNEAPOLIS |
| Zip Code | 55415 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.