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NPI Code Detail

MEDICARE: STEVEN JAMES AHLVERS ATC

MEDICARE: STEVEN JAMES AHLVERS ATC
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
12255A2300XAthletic Trainer1419MN

General Provider Information

NPI Number : 1104890904
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN JAMES AHLVERS ATC
Provider Business Mailing Address
First Line : 9815 UPPER 205TH ST W
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-5934
Country : US
Telephone Number : 651-210-8696
Fax Number :
Provider Business Practice Location Address
First Line : 4010 W 65TH ST
Second Line :
City : EDINA
State : MN
Zip : 55435-1706
Country : US
Telephone Number : 651-210-8696
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2006
Last Update Date : 10/10/2012

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Directions to “ STEVEN JAMES AHLVERS ATC” Practice Location

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