Provider Demographics
NPI:1710976337
Name:DAHLKE, STEVEN K (MD PEDIATRICS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:K
Last Name:DAHLKE
Suffix:
Gender:M
Credentials:MD PEDIATRICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:1590 PASEO SAN LUIS
Practice Address - Street 2:SUITE 102
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4782
Practice Address - Country:US
Practice Address - Phone:520-459-0203
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7658208000000X
AZ50097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805290700Medicaid
IDDX142OtherBLUE CROSS OF ID
ID000010004986OtherREGENCE BLUE SHIELD