Basic Information
| Provider Information | |||||||||
| NPI: | 1972867810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARNEVIK | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19942 SAINT JOSEPH DRIVE | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525448849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418568684 | ||||||||
| FaxNumber: | 6418563009 | ||||||||
| Practice Location | |||||||||
| Address1: | 19942 SAINT JOSEPH DR | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525448849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418568684 | ||||||||
| FaxNumber: | 6418563009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4305 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1972867810 | 05 | IA | MEDICAID |