1083858922 NPI number — MR. PATRICK J DAHMEN LICENSED MARITAL AND

Table of content: MR. PATRICK J DAHMEN LICENSED MARITAL AND (NPI 1083858922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083858922 NPI number — MR. PATRICK J DAHMEN LICENSED MARITAL AND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAHMEN
Provider First Name:
PATRICK
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED MARITAL AND
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083858922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7326 CLOVER HILL DRIVE
Provider Second Line Business Mailing Address:
PATRICK DAHMEN
Provider Business Mailing Address City Name:
WAUNAKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-212-5434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 WALDEN OFFICE SQUARE
Provider Second Line Business Practice Location Address:
GATEWAY EXECUTIVE PARK CENTER
Provider Business Practice Location Address City Name:
SCHAUMBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-812-0704
Provider Business Practice Location Address Fax Number:
847-303-1121
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  166000247 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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