Ethan Dennis Dahl

Primary specialty

Basic Emergency Medical TechnicianTaxonomy code 146N00000X

License

060783107 Issued in IL

Practice address

306 Washington St
Ingleside, IL 60041-8324

Phone

(847) 587-3312

NPI assigned

Jul 21, 2021

Last updated

Jul 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fox Lake Fire Protection District

  • Land Ambulance
  • Ingleside, IL
  • NPI 1144461278
  NPD (past)
• Fox Lake Fire Protection District

  • Land Ambulance
  • Ingleside, IL
  • NPI 1174759294
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1194398776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 WASHINGTON ST",
            "city": "INGLESIDE",
            "state": "IL",
            "postal_code": "600418324",
            "telephone_number": "847-587-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 WASHINGTON ST",
            "city": "INGLESIDE",
            "state": "IL",
            "postal_code": "600418324",
            "telephone_number": "847-587-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHL",
        "first_name": "ETHAN",
        "middle_name": "DENNIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "IL",
            "license": "060783107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Affiliated Ear, Nose and Throat Physicians
• All Time Urgent Care LLC
• Big Hollow School District 38
• Cecelia Blue
• Michelle Elizabeth Dace, FNP-BC
• William C Dam, MD
• Dean S. Economos, MD, SC
• Domenico PLLC
• Jane Brigette Dorado, R.N.
• Dean Spiros Economos, M.D.

• Basic Emergency Medical Technician in Ingleside, IL
• Providers in Ingleside, IL by specialty
• Basic Emergency Medical Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.