Basic Information
| Provider Information | |||||||||
| NPI: | 1710976337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAHLKE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD. PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 F AVE | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856071920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203641429 | ||||||||
| FaxNumber: | 5203644261 | ||||||||
| Practice Location | |||||||||
| Address1: | 1590 PASEO SAN LUIS | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856354782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204590203 | ||||||||
| FaxNumber: | 5203644261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 03/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | M7658 | ID | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 50097 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 805290700 | 05 | ID | MEDICAID | DX142 | 01 | ID | BLUE CROSS OF ID | OTHER | 000010004986 | 01 | ID | REGENCE BLUE SHIELD | OTHER |