MEDICARE: DR. ARUNTHATHI TABITHA STALLWOOD 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	207R00000X	Internal Medicine Physician	4301099109	MI
2	208000000X	Pediatrics Physician	4301099109	MI

General Provider Information

NPI Number	:	1972899680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARUNTHATHI TABITHA STALLWOOD MD

Provider Business Mailing Address
First Line	:	PO BOX 610669
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48061-0669
Country	:	US
Telephone Number	:	810-985-1884
Fax Number	:	810-966-3025

Provider Business Practice Location Address
First Line	:	1985 GRATIOT BLVD
Second Line	:
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-2215
Country	:	US
Telephone Number	:	810-364-0692
Fax Number	:	810-364-0698

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	07/07/2015

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