Active NPI
Arnold C. Fellman, M.D., P.C.
- Dermatology Physician
- Pontiac, MI
National Provider Identifier
1295931517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 4301029683
- Legal business name
- ARNOLD C. FELLMAN, M.D., P.C.
- Practice address
- 1701 Baldwin Ave
Suite 207
Pontiac, MI 48340-3412 - Phone
- (248) 858-2255
- Fax
- (248) 858-8010
- NPI assigned
- Jun 24, 2007
- Last updated
- Feb 28, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Arnold C. Fellman, M.D.
- Title
- President
- Phone
- (248) 858-2255
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301029683 | MI | Primary |
| Dermatopathology Physician | 207ND0900X | 4301029683 | MI | |
| Clinical & Laboratory Dermatological Immunology Physician | 207NI0002X | 4301029683 | MI | |
| Pediatric Dermatology Physician | 207NP0225X | 4301029683 | MI | |
| Procedural Dermatology Physician | 207NS0135X | 4301029683 | MI |
Addresses
Primary practice location
1701 Baldwin Ave
Suite 207
Pontiac, MI 48340-3412
Mailing address
1701 Baldwin Ave
Suite 207
Pontiac, MI 48340-3412
Phone (248) 858-2255
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101063382 | Medicaid | MI | |
| 4033181 | Other | MI | AETNA |
| MO13980 | Other | MI | CHAMPUS |
| 01361A | Other | MI | HAP |
| 070F339580 | Other | MI | BLUE CARE NETWORK |
| 71045012 | Other | MI | MEDICARE TRAVELERS |
| 070F339580 | Other | MI | BLUE CROSS BLUE SHIELD |
| 0P46320 | Other | MI | MEDICARE GROUP NUMBER |
National Provider Directory
National Provider DirectoryLocations
1701 Baldwin Ave
Ste 207
Pontiac, MI 48340
Phone (248) 858-2255
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Dermatology Physician
- Pontiac, MI
- NPI 1770571424
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182643200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1204156800000",
"number": "1295931517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 BALDWIN AVE",
"address_2": "SUITE 207",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483403412",
"telephone_number": "248-858-2255",
"fax_number": "248-858-8010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 BALDWIN AVE",
"address_2": "SUITE 207",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483403412",
"telephone_number": "248-858-2255",
"fax_number": "248-858-8010"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ARNOLD C. FELLMAN, M.D., P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-24",
"last_updated": "2008-02-28",
"status": "A",
"authorized_official_last_name": "FELLMAN",
"authorized_official_first_name": "ARNOLD",
"authorized_official_middle_name": "C.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "248-858-2255",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "4301029683",
"primary": true
},
{
"code": "207ND0900X",
"taxonomy_group": "",
"desc": "Dermatology, Dermatopathology",
"state": "MI",
"license": "4301029683",
"primary": false
},
{
"code": "207NI0002X",
"taxonomy_group": "",
"desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
"state": "MI",
"license": "4301029683",
"primary": false
},
{
"code": "207NP0225X",
"taxonomy_group": "",
"desc": "Dermatology, Pediatric Dermatology",
"state": "MI",
"license": "4301029683",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "MI",
"license": "4301029683",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101063382",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4033181",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "MO13980",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAP",
"identifier": "01361A",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "070F339580",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE TRAVELERS",
"identifier": "71045012",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "070F339580",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "0P46320",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.