MEDICARE: JUSTIN R. AHLMAN, 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	036113723	IL
2	207L00000X	Anesthesiology Physician	036113723	IL

General Provider Information

NPI Number	:	1518387109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTIN R. AHLMAN, M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3092
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61612-3092
Country	:	US
Telephone Number	:	309-264-6124
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 W WILLOW KNOLLS DR
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-8148
Country	:	US
Telephone Number	:	309-264-6124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN R AHLMAN
Credential	:	M.D.
Telephone Number	:	309-264-6124

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/22/2014

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