Provider Demographics
NPI:1154371367
Name:DAHLGREN, MATTHEW ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:DAHLGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1311 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4375
Mailing Address - Country:US
Mailing Address - Phone:262-723-4600
Mailing Address - Fax:262-723-4710
Practice Address - Street 1:1311 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4375
Practice Address - Country:US
Practice Address - Phone:262-723-4600
Practice Address - Fax:262-723-4710
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48956-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34667800Medicaid
WI34667800Medicaid
WI002702650Medicare PIN
WI34667800Medicaid
WI$$$$$$$$$006OtherANTHEM BCBS
WI002368570Medicare PIN