Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301029683 | MI |
N | 207ND0900X | Dermatopathologist | 4301029683 | MI |
N | 207NP0225X | Pediatric Dermatologist | 4301029683 | MI |
N | 207NS0135X | Procedural Dermatology | 4301029683 | MI |
NPI | 1770571424 |
---|---|
Provider Name | Dr. Arnold C. Fellman |
First Address | Pontiac, MI 48340-3412 |
Second Address | Pontiac, MI 48340-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01361A | HAP (01) | MI |
0706316251 | BLUE CARE NETWORK (01) | MI |
0706316251 | BLUE CROSS BLUE SHIELD (01) | MI |
4033181 | AETNA (01) | MI |
71045012 | MEDICARE TRAVELERS (01) | MI |
E25486 | (02) | MI |
MO13980 | CHAMPUS (01) | MI |