Provider Demographics
NPI:1942387527
Name:ARRIOLA, LOURDES WHITE
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:WHITE
Last Name:ARRIOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:WHITE
Other - Last Name:ARRIOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:30852 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2606
Mailing Address - Country:US
Mailing Address - Phone:248-477-0112
Mailing Address - Fax:248-477-9365
Practice Address - Street 1:30852 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2606
Practice Address - Country:US
Practice Address - Phone:248-477-0112
Practice Address - Fax:248-477-9365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID83168Medicare UPIN
MI0631180Medicare ID - Type Unspecified