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General NPI Number Information
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NPI Number | 1205178381
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Entity Type | Individual
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Provider Name | ANDREW MICHAEL DAHLEM JR. M. D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 4999 OLD ORCHARD SHOPPING CENTER N10 & N7
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City | SKOKIE
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State | IL
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Zip | 60077
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Country | US
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Telephone | 405-658-6791
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EMBARCADERO CTR STE 1900
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3723
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Country | US
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Telephone | 405-658-6791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036138940
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License Number State | IL
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