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General NPI Number Information
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NPI Number | 1518387109
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Entity Type | Organization
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Legal Business Name | JUSTIN R. AHLMAN, M.D.
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 3322 W WILLOW KNOLLS DR
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City | PEORIA
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State | IL
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Zip | 61614-8148
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Country | US
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Telephone | 309-264-6124
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3092
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City | PEORIA
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State | IL
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Zip | 61612-3092
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Country | US
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Telephone | 309-264-6124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN R AHLMAN
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Credential | M.D.
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Telephone | 309-264-6124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036113723
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036113723
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License Number State | IL
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