MEDICARE: EXTENDED CARE MEDICAL ASSOC. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	AH005640	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144261488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED CARE MEDICAL ASSOC. PC

Provider Business Mailing Address
First Line	:	PO BOX 251642
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48325-1642
Country	:	US
Telephone Number	:	248-681-1963
Fax Number	:	248-681-3524

Provider Business Practice Location Address
First Line	:	4748 S KNOLL CT
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48323-2520
Country	:	US
Telephone Number	:	248-681-1963
Fax Number	:	248-681-3524

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. ARTHUR HAROLD
Credential	:	DO
Telephone Number	:	248-681-1963

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	08/22/2020

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