Provider Demographics
NPI:1295931517
Name:ARNOLD C. FELLMAN, M.D., P.C.
Entity type:Organization
Organization Name:ARNOLD C. FELLMAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-858-2255
Mailing Address - Street 1:1701 BALDWIN AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-3412
Mailing Address - Country:US
Mailing Address - Phone:248-858-2255
Mailing Address - Fax:248-858-8010
Practice Address - Street 1:1701 BALDWIN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3412
Practice Address - Country:US
Practice Address - Phone:248-858-2255
Practice Address - Fax:248-858-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-24
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029683207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101063382Medicaid
MI0P46320OtherMEDICARE GROUP NUMBER
MI01361AOtherHAP
MI070F339580OtherBLUE CROSS BLUE SHIELD
MI4033181OtherAETNA
MIMO13980OtherCHAMPUS
MI71045012OtherMEDICARE TRAVELERS
MI070F339580OtherBLUE CARE NETWORK
MIE25486Medicare UPIN
MI101063382Medicaid