Basic Information
| Provider Information | |||||||||
| NPI: | 1407814635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAHLBERG | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122624813 | ||||||||
| FaxNumber: | 6122624194 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 W 66TH ST | ||||||||
| Address2: | |||||||||
| City: | RICHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554232304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127988800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 09/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 1689 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 49738 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD440013 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 54081 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD440013 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 415288 | 01 | PA | UPMC-WMG | OTHER | 1591277 | 01 | PA | GATEWAY-WMG | OTHER | 2514078 | 01 | PA | HIGHMARK BLUE SHIELD-WMG | OTHER | 102483179 | 05 | PA | MEDICAID |