Provider Demographics
NPI:1821198243
Name:INTANO-ARCA, CORAZON (MD)
Entity type:Individual
Prefix:MRS
First Name:CORAZON
Middle Name:
Last Name:INTANO-ARCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8033 E 10 MILE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1427
Mailing Address - Country:US
Mailing Address - Phone:586-977-2900
Mailing Address - Fax:586-977-2900
Practice Address - Street 1:8033 E. TEN MILE
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTERLINE
Practice Address - State:MI
Practice Address - Zip Code:48015
Practice Address - Country:US
Practice Address - Phone:586-977-2900
Practice Address - Fax:586-977-2992
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032630208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104294015Medicaid
3506356272OtherBCBSM
MI4294015Medicaid
MI3506356272OtherBCBSM
MIE68083Medicare UPIN
MI4294015Medicaid