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1356330005

NPI Code Detail

MEDICARE: DR. TODD L ENGDAHL MD

MEDICARE: DR. TODD L ENGDAHL 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	207P00000X	Emergency Medicine Physician	036113579	IL
2	207P00000X	Emergency Medicine Physician	036113579	OH
3	207P00000X	Emergency Medicine Physician	E-14230	AR
4	207P00000X	Emergency Medicine Physician	35101	KY

General Provider Information

NPI Number	:	1356330005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD L ENGDAHL MD

Provider Business Mailing Address
First Line	:	4750 HEMPSTEAD STATION DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5164
Country	:	US
Telephone Number	:	800-875-0136
Fax Number	:	937-619-4231

Provider Business Practice Location Address
First Line	:	3333 W DEYOUNG ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-5884
Country	:	US
Telephone Number	:	618-998-7000
Fax Number	:	618-997-6589

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	09/08/2021

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Directions to “ DR. TODD L ENGDAHL MD” Practice Location

Language	Start Address	Practice Location

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