Basic Information
| Provider Information | |||||||||
| NPI: | 1033448337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID D. AICHHOLZ MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4834 SOCIALVILLE FOSTER RD | ||||||||
| Address2: | SUITE 60 | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132298010 | ||||||||
| FaxNumber: | 5132298014 | ||||||||
| Practice Location | |||||||||
| Address1: | 4834 SOCIALVILLE FOSTER RD | ||||||||
| Address2: | SUITE 60 | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132298010 | ||||||||
| FaxNumber: | 5132298014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2009 | ||||||||
| LastUpdateDate: | 12/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | AICHHOLZ | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 5132298010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35061932A | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0111364 | 05 | OH | MEDICAID |