MEDICARE: DR. SANDRA J AHLUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	R1C75	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427037183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA J AHLUM M.D.

Provider Business Mailing Address
First Line	:	100 MEDICAL DR
Second Line	:	P.O. BOX 311
City	:	HANNIBAL
State	:	MO
Zip	:	63401-6877
Country	:	US
Telephone Number	:	573-231-3108
Fax Number	:	573-231-3721

Provider Business Practice Location Address
First Line	:	100 MEDICAL DR
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-6877
Country	:	US
Telephone Number	:	573-231-3108
Fax Number	:	573-231-3721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	02/14/2021

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