Provider Demographics
NPI:1124248158
Name:PANCIOLI, ARTHUR PRIMO (DO)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:PRIMO
Last Name:PANCIOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4895 VAN AMBERG RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9201
Mailing Address - Country:US
Mailing Address - Phone:810-227-2577
Mailing Address - Fax:
Practice Address - Street 1:4895 VAN AMBERG RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9201
Practice Address - Country:US
Practice Address - Phone:810-227-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005505207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAPPFO3721Medicare UPIN