MEDICARE: MRS. CORAZON INTANO-ARCA 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	208D00000X	General Practice Physician	4301032630	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
2	3506356272	OTHER		BCBSM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3506356272	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1821198243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORAZON INTANO-ARCA M.D.

Provider Business Mailing Address
First Line	:	8033 E 10 MILE RD
Second Line	:	SUITE 101
City	:	CENTER LINE
State	:	MI
Zip	:	48015-1427
Country	:	US
Telephone Number	:	586-977-2900
Fax Number	:	586-977-2900

Provider Business Practice Location Address
First Line	:	8033 E. TEN MILE
Second Line	:	SUITE 101
City	:	CENTERLINE
State	:	MI
Zip	:	48015
Country	:	US
Telephone Number	:	586-977-2900
Fax Number	:	586-977-2992

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/09/2013

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