MEDICARE: KATHLEEN ANNA DAHLMANN 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	208000000X	Pediatrics Physician	17988	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23173	OTHER	OK	OBNDD

General Provider Information

NPI Number	:	1508934597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANNA DAHLMANN MD

Provider Business Mailing Address
First Line	:	P.O. BOX 160
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761
Country	:	US
Telephone Number	:	918-326-4983
Fax Number	:	918-326-4983

Provider Business Practice Location Address
First Line	:	101 W UNIVERSITY ST
Second Line	:	BOX 160
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-2663
Country	:	US
Telephone Number	:	918-326-4983
Fax Number	:	918-326-4983

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	03/07/2023

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