Provider Demographics
NPI:1972556504
Name:AHLBERG, DANIEL BERTON (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:BERTON
Last Name:AHLBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4440 TYROL CRST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3554
Mailing Address - Country:US
Mailing Address - Phone:763-427-8547
Mailing Address - Fax:763-576-5394
Practice Address - Street 1:4440 TYROL CRST
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55416-3554
Practice Address - Country:US
Practice Address - Phone:763-427-8547
Practice Address - Fax:763-576-5394
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN19682207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95438Medicare UPIN