Provider Demographics
NPI:1003013657
Name:SPINALE, RICHARD C (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:SPINALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-427-6570
Mailing Address - Fax:734-427-6140
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-427-6570
Practice Address - Fax:734-427-6140
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI009110208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2842362Medicaid
MI5820254Medicare ID - Type Unspecified
MIE38094Medicare UPIN