Provider Demographics
NPI:1316979370
Name:ARENS, MARY (MS PAC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ARENS
Suffix:
Gender:F
Credentials:MS PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16151 19 MILE ROAD, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-228-1760
Mailing Address - Fax:586-228-2672
Practice Address - Street 1:16151 19 MILE ROAD, SUITE 300
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-228-1760
Practice Address - Fax:586-228-2672
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI003378363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP69885Medicare UPIN