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General NPI Number Information
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NPI Number | 1417937632
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Entity Type | Individual
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Provider Name | ALPHEUS T APPENHEIMER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | KSB MEDICAL GROUP 102 S HENNEPIN AVE
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City | DIXON
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State | IL
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Zip | 61021
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Country | US
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Telephone | 815-288-7711
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Fax | 815-285-8903
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Provider Business Mailing Address
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Address Line | 403 E 1ST ST
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City | DIXON
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State | IL
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Zip | 61021-3116
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Country | US
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Telephone | 815-285-8504
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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 | 036-058868
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 036-058868
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 036-058868
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License Number State | IL
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