MEDICARE: DANIEL BERTON AHLBERG 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	207T00000X	Neurological Surgery Physician	19682	MN

General Provider Information

NPI Number	:	1972556504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL BERTON AHLBERG M.D.

Provider Business Mailing Address
First Line	:	4440 TYROL CRST
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55416-3554
Country	:	US
Telephone Number	:	763-427-8547
Fax Number	:	763-576-5394

Provider Business Practice Location Address
First Line	:	4440 TYROL CRST
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55416-3554
Country	:	US
Telephone Number	:	763-427-8547
Fax Number	:	763-576-5394

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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