Provider Demographics
NPI: | 1710988795 |
---|---|
Name: | AHLFELD, STEVEN KRIS (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | STEVEN |
Middle Name: | KRIS |
Last Name: | AHLFELD |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | STEVEN |
Other - Middle Name: | KRIS |
Other - Last Name: | AHLFELD |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 9302 N MERIDIAN ST |
Mailing Address - Street 2: | SUITE 110 |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46260-1873 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-575-6515 |
Mailing Address - Fax: | 317-844-8347 |
Practice Address - Street 1: | 9302 N MERIDIAN ST |
Practice Address - Street 2: | SUITE 110 |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46260-1873 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-575-6515 |
Practice Address - Fax: | 317-844-8347 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-08-02 |
Last Update Date: | 2024-02-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01028922 | 207XX0005X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 822770 | Medicaid | |
IN | 822770 | Medicare PIN | |
IN | D70783 | Medicare UPIN | |
IN | 256560A | Medicare PIN |