Healthcare Provider Details

I. General information

NPI: 1730167636
Provider Name (Legal Business Name): HARRY JAMES ARETAKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD EMERGENCY MEDICINE DEPARTMENT
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

38935 ANN ARBOR ROAD CREDENTIALING/PAYER CONTRACTING SERVICES
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2601
  • Fax: 586-263-2589
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301041797
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301041797
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD433111
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101243542
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: