MEDICARE: ASHLEY P DALTON PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1104029206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY P DALTON PA-C

Provider Business Mailing Address
First Line	:	880 W CENTRAL RD
Second Line	:	# 3800
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-2355
Country	:	US
Telephone Number	:	847-255-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 W CENTRAL RD
Second Line	:	# 3800
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-2355
Country	:	US
Telephone Number	:	847-255-0900
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	11/23/2016

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