Provider Demographics
NPI:1730167636
Name:ARETAKIS, HARRY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JAMES
Last Name:ARETAKIS
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 1:38935 ANN ARBOR ROAD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING SERVICES
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:15855 19 MILE RD
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3504
Practice Address - Country:US
Practice Address - Phone:586-263-2601
Practice Address - Fax:586-263-2589
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041797207PE0004X, 207P00000X
PAMD433111207P00000X
VA0101243542207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
11270931OtherCAQH
MI10-4586010Medicaid
MI10-4586029Medicaid
MI10-4958080Medicaid
MIN87430028Medicare ID - Type UnspecifiedPEC SJMM (PHYSICIANS)
MI10-4585999Medicaid
MI10-4586047Medicaid
11270931OtherCAQH
MI0106306071OtherBCBS
P00260171OtherRAILROAD MEDICARE
MIB47239Medicare UPIN
MIP00260171Medicare ID - Type UnspecifiedRAILROAD
MI10-4586000Medicaid
MIQ26294380Medicare ID - Type UnspecifiedPEC OKW (PHYSICIANS)
MI10-4986011Medicaid