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General NPI Number Information
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NPI Number | 1326273293
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Entity Type | Individual
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Provider Name | ELIZABETH R DAHLBERG M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 373 MERIDIAN PARKE LN STE. E
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City | GREENWOOD
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State | IN
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Zip | 46142-9420
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Country | US
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Telephone | 317-893-2364
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Fax | 317-851-8066
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Provider Business Mailing Address
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Address Line | 373 MERIDIAN PARKE LN STE. E
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City | GREENWOOD
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State | IN
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Zip | 46142-9420
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Country | US
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Telephone | 317-893-2364
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Fax | 317-851-8066
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 11014889A
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License Number State | IN
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