Provider Demographics
NPI:1134399975
Name:NINA ARAKELOVA MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CEN
Entity type:Organization
Organization Name:NINA ARAKELOVA MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PROVIDENCE HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:PO BOX 12093
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0093
Mailing Address - Country:US
Mailing Address - Phone:913-825-6512
Mailing Address - Fax:913-328-7011
Practice Address - Street 1:5701 STATE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1236
Practice Address - Country:US
Practice Address - Phone:913-287-7800
Practice Address - Fax:913-287-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty