Basic Information
| Provider Information | |||||||||
| NPI: | 1750318218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAHLBERG | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 BERGSLIEN ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540022600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156841111 | ||||||||
| FaxNumber: | 7156841119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BERGSLIEN ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156841111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/12/2018 | ||||||||
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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 | 208600000X | 36075 | MN | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 36075 | MN | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 128184 | 01 | MN | UCARE | OTHER | 110A6DA | 01 | MN | BCBS | OTHER | 17-00867 | 01 | FM | MEDICA CHOICE & PRIMARY | OTHER | HP33647 | 01 | MN | HEALTHPARTNERS | OTHER | 0085391 | 05 | MT | MEDICAID | 34808300 | 05 | WI | MEDICAID | 1344965 | 01 | MN | ARAZ | OTHER | 744218100 | 05 | MN | MEDICAID | 1028023 | 01 | MN | PREFERRED ONE | OTHER |