Provider Demographics
NPI:1184830234
Name:ARTHUR R JEYNES DPM PC
Entity Type:Organization
Organization Name:ARTHUR R JEYNES DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:RALEIGH
Authorized Official - Last Name:JEYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:231-779-3668
Mailing Address - Street 1:8805 PINE RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2373
Mailing Address - Country:US
Mailing Address - Phone:231-779-3668
Mailing Address - Fax:231-779-4496
Practice Address - Street 1:8805 PINE RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2373
Practice Address - Country:US
Practice Address - Phone:231-779-3668
Practice Address - Fax:231-779-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAJ002019213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4280118Medicaid
MI4858350010OtherBLUE CROSS
MI480H310540OtherBLUE CROSS GROUP
MI129572OtherPREFERRED CHOICE
MI4280118Medicaid
MI129572OtherPREFERRED CHOICE
MI4858350010OtherBLUE CROSS
MI5081170001Medicare NSC