Provider Demographics
NPI:1043298466
Name:MAGYAR, DAVID M (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MAGYAR
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:PO BOX 673739
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3739
Mailing Address - Country:US
Mailing Address - Phone:313-299-6650
Mailing Address - Fax:313-299-6651
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:STE 109
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-299-6650
Practice Address - Fax:313-299-6651
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007496207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4194464Medicaid
MIB45207OtherUPIN
MI4363765OtherAETNA
MIDM007496OtherLICENSE
MI109302OtherPREF CHOICE/CARE CHOICE
0N18750Medicare ID - Type Unspecified
E49380Medicare UPIN