Provider Demographics
NPI:1003349028
Name:PRIMDAHL, DITTE (MD)
Entity type:Individual
Prefix:
First Name:DITTE
Middle Name:
Last Name:PRIMDAHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 20-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5970
Mailing Address - Country:US
Mailing Address - Phone:312-695-4360
Mailing Address - Fax:312-695-1435
Practice Address - Street 1:675 N SAINT CLAIR ST STE 20-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5970
Practice Address - Country:US
Practice Address - Phone:312-695-4360
Practice Address - Fax:312-695-1435
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI282N00000X
IL0361691182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No282N00000XHospitalsGeneral Acute Care Hospital