Provider Demographics
NPI:1932666880
Name:ARBOUR, TRACEY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:A
Last Name:ARBOUR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47205 SCARLET DR S
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3448
Mailing Address - Country:US
Mailing Address - Phone:248-982-6690
Mailing Address - Fax:
Practice Address - Street 1:47205 SCARLET DR S
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-3448
Practice Address - Country:US
Practice Address - Phone:248-982-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001183213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery