Provider Demographics
NPI:1104829381
Name:AHRENS, EDWIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:M
Last Name:AHRENS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:310 E BROADWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1745
Mailing Address - Country:US
Mailing Address - Phone:502-585-5249
Mailing Address - Fax:502-585-5251
Practice Address - Street 1:310 E BROADWAY
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1745
Practice Address - Country:US
Practice Address - Phone:502-585-5249
Practice Address - Fax:502-585-5251
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-16
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Provider Licenses
StateLicense IDTaxonomies
KY22183207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC64710Medicare UPIN
KY1316809Medicare ID - Type Unspecified