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Diane R Kaltenberg-Ahlers

Anesthesiology

Allopathic & Osteopathic Physicians

6500 Excelsior Blvd, St Louis Park, MN 55426-4702

PECOS Enrollment

This provider is enrolled in PECOS as DIANE KALTENBERG-AHLERS.

Based on the most recent information from CMS, provider Diane R Kaltenberg-Ahlers is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1487600680
Provider Type
Individual
Full Name
Kaltenberg-Ahlers, Diane R
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
5/26/2006
Last Updated
6/24/2010

Contact Information

Practice Location

6500 Excelsior Blvd, St Louis Park, MN 55426-4702

(952) 920-0845

Unlisted Fax

Mailing Location

PO Box 47159, Plymouth, MN 55447-0159

(763) 559-3779

(763) 450-3986

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License 35938 Minnesota

Provider Identifiers

ID	Description	Issuer
ID 881595000	Description Medicaid	Issuer Unlisted Minnesota

Diane R Kaltenberg-Ahlers

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Peterson, Bradley J

Leonovicz, Brian M

Lyons, Michael J

Jaksa, Robert J

Katta, Gaurav Reddy

Hoops, David E

Yasmineh, David J

Swanlund, Eric G

Lyons, Thomas E

Newcome, John P