Provider Demographics
NPI:1326140906
Name:ARBOGAST, JONATHAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:ARBOGAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 W VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2809
Mailing Address - Country:US
Mailing Address - Phone:810-686-3747
Mailing Address - Fax:810-686-4794
Practice Address - Street 1:4154 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9402
Practice Address - Country:US
Practice Address - Phone:810-686-3747
Practice Address - Fax:810-686-4794
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4507197Medicaid
MIM23560182Medicare PIN
MI4507197Medicaid