Provider Demographics
NPI:1891451035
Name:ARBOR AUTISM PEDIATRIC MEDICAL CENTERS PLLC
Entity Type:Organization
Organization Name:ARBOR AUTISM PEDIATRIC MEDICAL CENTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-657-1470
Mailing Address - Street 1:850 S HEWITT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4594
Mailing Address - Country:US
Mailing Address - Phone:734-544-5561
Mailing Address - Fax:734-527-5981
Practice Address - Street 1:850 S HEWITT RD STE 100
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4594
Practice Address - Country:US
Practice Address - Phone:734-544-5561
Practice Address - Fax:734-527-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty