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NPI Code Detail

MEDICARE: ERIN DAHLKE D.O.

MEDICARE: ERIN DAHLKE D.O.
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
1207Q00000XFamily Medicine Physician036163548IL
2207QH0002XHospice and Palliative Medicine (Family Medicine) Physician036163548IL
3390200000XStudent in an Organized Health Care Education/Training ProgramNE
4207Q00000XFamily Medicine Physician1123NE

General Provider Information

NPI Number : 1134488554
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN DAHLKE D.O.
Provider Business Mailing Address
First Line : 1725 W HARRISON ST STE 10
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3849
Country : US
Telephone Number : 312-563-3700
Fax Number :
Provider Business Practice Location Address
First Line : 4200 DOUGLAS ST
Second Line :
City : OMAHA
State : NE
Zip : 68131-2705
Country : US
Telephone Number : 402-552-3222
Fax Number : 402-552-2172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2012
Last Update Date : 03/23/2023

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