Provider Demographics
NPI:1750719944
Name:DAHLEEN, CALLIE (PA-C)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:DAHLEEN
Suffix:
Gender:F
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 1:4885 HOFFMAN BLVD
Mailing Address - Street 2:STE 407
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-3726
Mailing Address - Country:US
Mailing Address - Phone:224-484-0183
Mailing Address - Fax:224-699-9301
Practice Address - Street 1:4885 HOFFMAN BLVD
Practice Address - Street 2:STE 407
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-3726
Practice Address - Country:US
Practice Address - Phone:630-455-1756
Practice Address - Fax:630-455-1759
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004895207N00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology