Healthcare Provider Details

I. General information

NPI: 1033118724
Provider Name (Legal Business Name): JOHN B ARKUSINSKI DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E. MAIN STREET
ITALY TX
76651
US

IV. Provider business mailing address

204 E. MAIN STREET
ITALY TX
76651
US

V. Phone/Fax

Practice location:
  • Phone: 972-483-7979
  • Fax: 972-483-7922
Mailing address:
  • Phone: 972-483-7979
  • Fax: 972-483-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL3913
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN BRUNO ARKUSINSKI
Title or Position: OWNER
Credential: D.O.
Phone: 972-483-7979