Provider Demographics
NPI:1275376535
Name:AHRENHOLZ, SAMUEL JOHN (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOHN
Last Name:AHRENHOLZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:AHRENHOLZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5591 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-9433
Mailing Address - Country:US
Mailing Address - Phone:319-230-1148
Mailing Address - Fax:
Practice Address - Street 1:1415 WOODLAND AVE STE 140
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3203
Practice Address - Country:US
Practice Address - Phone:515-241-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-13266261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology