Provider Demographics
NPI:1265691554
Name:ARNOLD, MICHAEL IVAN (IDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:IVAN
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NEW CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4118
Mailing Address - Country:US
Mailing Address - Phone:760-805-6207
Mailing Address - Fax:
Practice Address - Street 1:328 W BIROS LN
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-5607
Practice Address - Country:US
Practice Address - Phone:760-805-6207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman