Individual
SCOTT AHLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
534 GREEN BAY RD, KENILWORTH, IL 60043-1801
(847) 256-5505
Mailing address
3021 IROQUOIS RD, WILMETTE, IL 60091-1106
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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