Provider Demographics
NPI:1548285851
Name:ARVANITIS, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ARVANITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-0704
Practice Address - Street 1:5221 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2022
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV222352085R0204X
OH35.0819732085R0202X
KY425142085R0204X
IN01074533A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000206603OtherUNISON
WV001804561OtherMTN ST BLUECROSS BLUESHIE
WVP00307254OtherRR MEDICARE (WV)
OH2374283Medicaid
IN201269740Medicaid
WV3810004339Medicaid
7640569OtherAETNA
KY50009663OtherPASSPORT
WV550493376 00OtherWORKER'S COMPENSATION (WV)
KY6411699900Medicaid
WV4177501Medicare PIN
OH000000206603OtherUNISON
7640569OtherAETNA
IN248640003Medicare PIN