Provider Demographics
NPI:1285662015
Name:PESOLA, DAVID ARVO (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARVO
Last Name:PESOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 WEST FAIR AVENUE
Mailing Address - Street 2:SUITE 334
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-3870
Mailing Address - Fax:906-225-4861
Practice Address - Street 1:1414 WEST FAIR AVENUE
Practice Address - Street 2:SUITE 334
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-3870
Practice Address - Fax:906-225-4861
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046757207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060029530OtherRAILROAD MEDICARE
MI0605200201OtherBLUE CROSS BLUE SHIELD
WI34966600Medicaid
MI1653745Medicaid
N85390010Medicare PIN
A75060Medicare UPIN
MI1653745Medicaid