Healthcare Provider Details

I. General information

NPI: 1174556880
Provider Name (Legal Business Name): ARTHUR MOELLER JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

IV. Provider business mailing address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-7795
  • Fax:
Mailing address:
  • Phone: 248-967-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5101018598
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: