Provider Demographics
NPI:1093552762
Name:ARBOR INTERNAL MEDICINE ASSOCIATION
Entity type:Organization
Organization Name:ARBOR INTERNAL MEDICINE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-382-3441
Mailing Address - Street 1:821 SW ALSBURY BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4090
Mailing Address - Country:US
Mailing Address - Phone:817-382-3441
Mailing Address - Fax:817-285-5556
Practice Address - Street 1:821 SW ALSBURY BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4090
Practice Address - Country:US
Practice Address - Phone:317-450-9811
Practice Address - Fax:817-285-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty