Provider Demographics
NPI:1063827152
Name:JONATHAN M HORBAL DO PLC
Entity Type:Organization
Organization Name:JONATHAN M HORBAL DO PLC
Other - Org Name:MIDLAND ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORBAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-631-1010
Mailing Address - Street 1:555 W WACKERLY ST
Mailing Address - Street 2:STE 2675
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4722
Mailing Address - Country:US
Mailing Address - Phone:989-631-1010
Mailing Address - Fax:989-839-8800
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:STE 2675
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4722
Practice Address - Country:US
Practice Address - Phone:989-631-1010
Practice Address - Fax:989-839-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018381207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5560079OtherBCBSM