MEDICARE: DR. EDWIN M AHRENS 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	207N00000X	Dermatology Physician	22183	KY

General Provider Information

NPI Number	:	1104829381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN M AHRENS MD

Provider Business Mailing Address
First Line	:	310 E BROADWAY
Second Line	:	STE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1745
Country	:	US
Telephone Number	:	502-585-5249
Fax Number	:	502-585-5251

Provider Business Practice Location Address
First Line	:	310 E BROADWAY
Second Line	:	STE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1745
Country	:	US
Telephone Number	:	502-585-5249
Fax Number	:	502-585-5251

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/16/2007

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