MEDICARE: DR. ERIC AHLGREN 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	2084P0800X	Psychiatry Physician	036-089919	IL

General Provider Information

NPI Number	:	1912280512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC AHLGREN M.D.

Provider Business Mailing Address
First Line	:	2136 W SUMMERDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1115
Country	:	US
Telephone Number	:	312-498-8159
Fax Number	:

Provider Business Practice Location Address
First Line	:	2136 W SUMMERDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1115
Country	:	US
Telephone Number	:	312-498-8159
Fax Number	:

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

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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