=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366517708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARBOR INTERNAL MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 09/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 MANCHESTER RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-4993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-973-4800
-----------------------------------------------------
Fax | 734-973-4810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1950 MANCHESTER RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-4993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-973-4800
-----------------------------------------------------
Fax | 734-973-4810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DR. JEAN SCHOLL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 734-973-4800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | CF046469
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | PS065397
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | JS040970
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------