Provider Demographics
NPI:1770571424
Name:FELLMAN, ARNOLD C (MD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:C
Last Name:FELLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029683207N00000X, 207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0706316251OtherBLUE CROSS BLUE SHIELD
MI4033181OtherAETNA
MI71045012OtherMEDICARE TRAVELERS
MI0706316251OtherBLUE CARE NETWORK
MI01361AOtherHAP
MIMO13980OtherCHAMPUS
MI71045012OtherMEDICARE TRAVELERS
MIP46320001Medicare PIN