1891909412 NPI number — MR. BRIAN WILLIAM ARROL OTL

Table of content: MR. BRIAN WILLIAM ARROL OTL (NPI 1891909412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891909412 NPI number — MR. BRIAN WILLIAM ARROL OTL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARROL
Provider First Name:
BRIAN
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OTL
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARROL
Provider Other First Name:
BRIAN
Provider Other Middle Name:
WILLIAM
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTL
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1891909412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11096 WATERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVISBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48350-3561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-892-1578
Provider Business Mailing Address Fax Number:
248-625-9203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11096 WATERSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVISBURG
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48350-3561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-625-9203
Provider Business Practice Location Address Fax Number:
248-625-9203
Provider Enumeration Date:
05/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  5201001520 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)