Provider Demographics
NPI:1578775581
Name:ARLENE KEVONIAN M.D. P.L.C.
Entity Type:Organization
Organization Name:ARLENE KEVONIAN M.D. P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PSYCHIATRY
Authorized Official - Prefix:MISS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:KEVONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD LPC
Authorized Official - Phone:248-626-8508
Mailing Address - Street 1:7031 ORCHARD LAKE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-626-8508
Mailing Address - Fax:
Practice Address - Street 1:7031 ORCHARD LAKE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-626-8508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2084P0800XOtherTAXONOMY
MI2084P0800XOtherTAXONOMY