Provider Demographics
NPI:1083635171
Name:CAPITOL NEUROLOGY PA
Entity Type:Organization
Organization Name:CAPITOL NEUROLOGY PA
Other - Org Name:NEIL R. DAHLQUIST MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACKLYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KWAPICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-291-1559
Mailing Address - Street 1:360 SHERMAN ST
Mailing Address - Street 2:SUITE #350
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2564
Mailing Address - Country:US
Mailing Address - Phone:651-291-1559
Mailing Address - Fax:651-291-0051
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE #350
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-291-1559
Practice Address - Fax:651-291-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN617523600Medicaid
MNCK5233OtherRAILROAD MEDICARE
MNCK5233OtherRAILROAD MEDICARE
WI000056130Medicare PIN
MNCO1550Medicare PIN