Basic Information
Provider Information
NPI: 1740770270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARVESCHOUG
FirstName: ANTHONY
MiddleName: STEVEN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26901 BEAUMONT BLVD STE 3D
Address2:  
City: SOUTHFIELD
State: MI
PostalCode: 480333849
CountryCode: US
TelephoneNumber: 9475221848
FaxNumber: 9475220307
Practice Location
Address1: 10000 TELEGRAPH RD STE 100
Address2:  
City: TAYLOR
State: MI
PostalCode: 481803330
CountryCode: US
TelephoneNumber: 3138876000
FaxNumber: 3138876005
Other Information
ProviderEnumerationDate: 05/10/2018
LastUpdateDate: 05/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X4301114827MIY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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