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1730167636

NPI Code Detail

MEDICARE: DR. HARRY JAMES ARETAKIS MD

MEDICARE: DR. HARRY JAMES ARETAKIS MD

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	4301041797	MI
2	207P00000X	Emergency Medicine Physician	4301041797	MI
3	207P00000X	Emergency Medicine Physician	MD433111	PA
4	207P00000X	Emergency Medicine Physician	0101243542	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11270931	OTHER		CAQH

General Provider Information

NPI Number	:	1730167636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY JAMES ARETAKIS MD

Provider Business Mailing Address
First Line	:	38935 ANN ARBOR ROAD
Second Line	:	CREDENTIALING/PAYER CONTRACTING SERVICES
City	:	LIVONIA
State	:	MI
Zip	:	48150-3397
Country	:	US
Telephone Number	:	734-632-0175
Fax Number	:	734-632-0182

Provider Business Practice Location Address
First Line	:	15855 19 MILE RD
Second Line	:	EMERGENCY MEDICINE DEPARTMENT
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-3504
Country	:	US
Telephone Number	:	586-263-2601
Fax Number	:	586-263-2589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	05/27/2014

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Directions to “ DR. HARRY JAMES ARETAKIS MD” Practice Location

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