Healthcare Provider Details

I. General information

NPI: 1720068810
Provider Name (Legal Business Name): SCOTT WARD AHRENHOLZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

IV. Provider business mailing address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-7800
  • Fax: 651-982-7539
Mailing address:
  • Phone: 651-982-7800
  • Fax: 651-982-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-7339
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number51314
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: