Healthcare Provider Details

I. General information

NPI: 1952863649
Provider Name (Legal Business Name): JUAN SEBASTIAN ARANA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 4TH ST
BRUNSWICK GA
31520-3779
US

IV. Provider business mailing address

3031 W GRAND BLVD STE 450
DETROIT MI
48202-3026
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-5870
  • Fax:
Mailing address:
  • Phone: 772-801-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101026297
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: