Provider Demographics
NPI:1972899680
Name:STALLWOOD, ARUNTHATHI TABITHA (MD)
Entity type:Individual
Prefix:DR
First Name:ARUNTHATHI
Middle Name:TABITHA
Last Name:STALLWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARUNTHATHI
Other - Middle Name:TABITHA
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 610669
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48061-0669
Mailing Address - Country:US
Mailing Address - Phone:810-985-1884
Mailing Address - Fax:810-966-3025
Practice Address - Street 1:1985 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2215
Practice Address - Country:US
Practice Address - Phone:810-364-0692
Practice Address - Fax:810-364-0698
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099109207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics