MEDICARE: THOMAS E DAHLBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	MD104392	MO
2	207Q00000X	Family Medicine Physician	MD104392	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080170409	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013013093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS E DAHLBERG MD

Provider Business Mailing Address
First Line	:	3322 S CAMPBELL AVE STE T-1
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-4980
Country	:	US
Telephone Number	:	417-220-4480
Fax Number	:	417-900-2992

Provider Business Practice Location Address
First Line	:	3322 S CAMPBELL AVE STE T-1
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-4980
Country	:	US
Telephone Number	:	417-220-4480
Fax Number	:	417-414-0017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/22/2024

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Directions to “ THOMAS E DAHLBERG MD” Practice Location

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