Healthcare Provider Details

I. General information

NPI: 1639376700
Provider Name (Legal Business Name): ARBOR TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MICHIGAN AVE
NORTH FOND DU LAC WI
54937-1317
US

IV. Provider business mailing address

PO BOX 811
FOND DU LAC WI
54936-0811
US

V. Phone/Fax

Practice location:
  • Phone: 920-923-4400
  • Fax:
Mailing address:
  • Phone: 920-923-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number08-00002413
License Number StateWI

VIII. Authorized Official

Name: MR. BLAISE G. HUBERTY
Title or Position: OWNER
Credential:
Phone: 920-923-4400