Provider Demographics
NPI:1366517708
Name:ARBOR INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:ARBOR INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-973-4800
Mailing Address - Street 1:1950 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4993
Mailing Address - Country:US
Mailing Address - Phone:734-973-4800
Mailing Address - Fax:734-973-4810
Practice Address - Street 1:1950 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4993
Practice Address - Country:US
Practice Address - Phone:734-973-4800
Practice Address - Fax:734-973-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICF046469207R00000X
MIPS065397207R00000X
MIJS040970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4552862Medicaid
MI4543460Medicaid
MI0N70350OtherMEDICARE GRP PIN
MI110H11004OtherBCBS MI GRP PIN
MI4543451Medicaid
MIB45374Medicare UPIN
MI4543460Medicaid
MI0N70350003Medicare ID - Type Unspecified
MI0N70350002Medicare ID - Type Unspecified
MI4552862Medicaid
MIG80874Medicare UPIN