MEDICARE: DR. ARNOLD C. FELLMAN M.D.

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	207N00000X	Dermatology Physician	4301029683	MI
2	207ND0900X	Dermatopathology Physician	4301029683	MI
3	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	4301029683	MI
4	207NP0225X	Pediatric Dermatology Physician	4301029683	MI
5	207NS0135X	Procedural Dermatology Physician	4301029683	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	71045012	OTHER	MI	MEDICARE TRAVELERS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0706316251	OTHER	MI	BLUE CROSS BLUE SHIELD
2	4033181	OTHER	MI	AETNA
4	0706316251	OTHER	MI	BLUE CARE NETWORK
5	01361A	OTHER	MI	HAP
6	MO13980	OTHER	MI	CHAMPUS

General Provider Information

NPI Number	:	1770571424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNOLD C. FELLMAN M.D.

Provider Business Mailing Address
First Line	:	1701 BALDWIN AVE
Second Line	:	SUITE 207
City	:	PONTIAC
State	:	MI
Zip	:	48340-3412
Country	:	US
Telephone Number	:	248-858-2255
Fax Number	:	248-858-8010

Provider Business Practice Location Address
First Line	:	1701 BALDWIN AVE
Second Line	:	SUITE 207
City	:	PONTIAC
State	:	MI
Zip	:	48340-3412
Country	:	US
Telephone Number	:	248-858-2255
Fax Number	:	248-858-8010

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	02/28/2008

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Directions to “ DR. ARNOLD C. FELLMAN M.D.” Practice Location

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