Healthcare Provider Details

I. General information

NPI: 1518043512
Provider Name (Legal Business Name): ARTHUR ROBERT VENDOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE SUITE 202
JACKSON MI
49201-1847
US

IV. Provider business mailing address

1100 E. MICHIGAN AVE SUITE 202
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-6210
  • Fax: 517-784-6144
Mailing address:
  • Phone: 517-784-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberAV074198
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: