Provider Demographics
NPI:1619494259
Name:DAHMS, ERIC LAWRENCE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LAWRENCE
Last Name:DAHMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CORPORATE WOODS PKWY
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3111
Mailing Address - Country:US
Mailing Address - Phone:847-634-9400
Mailing Address - Fax:847-634-2900
Practice Address - Street 1:555 CORPORATE WOODS PKWY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-3111
Practice Address - Country:US
Practice Address - Phone:847-634-9400
Practice Address - Fax:847-634-2900
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant