Healthcare Provider Details

I. General information

NPI: 1972968618
Provider Name (Legal Business Name): MR. GEORGE ARNOLD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W GRAND BLVD
DETROIT MI
48208-2336
US

IV. Provider business mailing address

18527 BRINKER ST
DETROIT MI
48234-1537
US

V. Phone/Fax

Practice location:
  • Phone: 313-324-8900
  • Fax: 313-324-8701
Mailing address:
  • Phone: 313-324-8900
  • Fax: 313-324-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: