Provider Demographics
NPI:1568561959
Name:ANDERSON, ARLETHA LENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ARLETHA
Middle Name:LENISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29255 NORTHWESTERN HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5741
Mailing Address - Country:US
Mailing Address - Phone:947-282-8380
Mailing Address - Fax:947-282-8378
Practice Address - Street 1:29255 NORTHWESTERN HWY STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5741
Practice Address - Country:US
Practice Address - Phone:947-282-8380
Practice Address - Fax:947-282-8378
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071086207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4674990Medicaid
MIH73962Medicare UPIN
MION68290Medicare ID - Type Unspecified