Organization
ARNOLD C. FELLMAN, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ARNOLD C. FELLMAN M.D. (PRESIDENT)
(248) 858-2255
Entity
Organization
Contact information
Practice address
1701 BALDWIN AVE, SUITE 207, PONTIAC, MI 48340-3412
(248) 858-2255
(248) 858-8010
Mailing address
1701 BALDWIN AVE, SUITE 207, PONTIAC, MI 48340-3412
(248) 858-2255
(248) 858-8010
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301029683
MI
207ND0900X
Dermatopathology Physician
4301029683
MI
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
4301029683
MI
207NP0225X
Pediatric Dermatology Physician
4301029683
MI
207NS0135X
Procedural Dermatology Physician
4301029683
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01361A
HAP
MI
01
—
070F339580
BLUE CROSS BLUE SHIELD
MI
01
—
0P46320
MEDICARE GROUP NUMBER
MI
05
—
101063382
—
MI
01
—
4033181
AETNA
MI
01
—
71045012
MEDICARE TRAVELERS
MI
01
—
MO13980
CHAMPUS
MI
Enumeration date
06/24/2007
Last updated
02/28/2008
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