MEDICARE: MR. GARY R AHNQUIST MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	19001	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	160033441	OTHER	KY	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07-00064	OTHER	KY	UNITED HEALTH CARE
4	19001	OTHER	KY	LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000000046066	OTHER	KY	BCBS
7	5731704	OTHER	KY	AETNA

General Provider Information

NPI Number	:	1336121672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY R AHNQUIST MD

Provider Business Mailing Address
First Line	:	333 S 3RD ST
Second Line	:	SUITE A
City	:	DANVILLE
State	:	KY
Zip	:	40422-2016
Country	:	US
Telephone Number	:	859-236-7712
Fax Number	:	859-236-7246

Provider Business Practice Location Address
First Line	:	333 S 3RD ST
Second Line	:	SUITE A
City	:	DANVILLE
State	:	KY
Zip	:	40422-2016
Country	:	US
Telephone Number	:	859-236-7712
Fax Number	:	859-236-7246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	01/05/2010

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Directions to “ MR. GARY R AHNQUIST MD” Practice Location

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