Provider Demographics
NPI:1760953897
Name:AHLSKOG, MATTHEW (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:AHLSKOG
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:2652 89TH CT W
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-4767
Mailing Address - Country:US
Mailing Address - Phone:507-358-3395
Mailing Address - Fax:
Practice Address - Street 1:1575 20TH ST NW STE 103
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2932
Practice Address - Country:US
Practice Address - Phone:651-249-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant