Healthcare Provider Details

I. General information

NPI: 1316914328
Provider Name (Legal Business Name): JUSTIN AHLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 N. IL ROUTE 91
PEORIA IL
61614
US

IV. Provider business mailing address

717 HIGHVIEW RD
EAST PEORIA IL
61611-1729
US

V. Phone/Fax

Practice location:
  • Phone: 309-683-4486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036113723
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036113723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: