Provider Demographics
NPI:1205178381
Name:DAHLEM, ANDREW MICHAEL JR (M D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:DAHLEM
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 N MILWAUKEE AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3165
Mailing Address - Country:US
Mailing Address - Phone:847-663-9700
Mailing Address - Fax:847-663-9702
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 18
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3165
Practice Address - Country:US
Practice Address - Phone:847-663-9700
Practice Address - Fax:847-663-9702
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036138940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036138940Medicaid
IL036138940Medicaid