Healthcare Provider Details

I. General information

NPI: 1205077336
Provider Name (Legal Business Name): LURLEY J. ARCHAMBEAU MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 WEATHERFIELD CT. STE. 1B
MAUMEE OH
43537-8919
US

IV. Provider business mailing address

6450 WEATHERFIELD CT. STE. 1B
MAUMEE OH
43537-8919
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-2830
  • Fax: 419-866-2831
Mailing address:
  • Phone: 419-866-2830
  • Fax: 419-866-2831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35999
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number35999
License Number StateOH

VIII. Authorized Official

Name: MAUREEN MARX
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-866-2830