Provider Demographics
NPI:1114909611
Name:EHLINGER, NORMAN J JR (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:J
Last Name:EHLINGER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 MCKELVEY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:3436A MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2525
Practice Address - Country:US
Practice Address - Phone:314-739-5518
Practice Address - Fax:314-739-1223
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8E76207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242167625Medicaid
MO005013849Medicare ID - Type Unspecified
MO242167625Medicaid
MO282050091Medicare PIN