Healthcare Provider Details

I. General information

NPI: 1891451035
Provider Name (Legal Business Name): ARBOR AUTISM PEDIATRIC MEDICAL CENTERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S HEWITT RD STE 100
YPSILANTI MI
48197-4594
US

IV. Provider business mailing address

850 S HEWITT RD STE 100
YPSILANTI MI
48197-4594
US

V. Phone/Fax

Practice location:
  • Phone: 734-544-5561
  • Fax: 734-527-5981
Mailing address:
  • Phone: 734-544-5561
  • Fax: 734-527-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP MENARD
Title or Position: MANAGER
Credential:
Phone: 734-657-1470