MEDICARE: DR. MICHELLE JEAN AHN M.D.

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	2084P0800X	Psychiatry Physician	036128718	IL
2	2084P0800X	Psychiatry Physician	A121280	CA

General Provider Information

NPI Number	:	1295902930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE JEAN AHN M.D.

Provider Business Mailing Address
First Line	:	9901 BRODIE LN STE 160-965
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 BRODIE LN STE 160-965
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5803
Country	:	US
Telephone Number	:	847-732-1128
Fax Number	:

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

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	10/13/2021

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