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General NPI Number Information
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NPI Number | 1265013619
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Entity Type | Individual
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Provider Name | DANIEL ROBERT WAHLSTROM MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2021
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 908 N ELM ST STE 110
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City | HINSDALE
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State | IL
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Zip | 60521-2600
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Country | US
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Telephone | 630-986-8770
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Fax | 630-986-8776
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Provider Business Mailing Address
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Address Line | PO BOX 713260
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City | CHICAGO
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State | IL
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Zip | 60677-1260
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Country | US
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Telephone | 630-469-9200
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 125-078946
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301514850
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036-171744
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License Number State | IL
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