Provider Demographics
NPI:1275882599
Name:AREGULLIN, OLIVER EZEKIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:EZEKIEL
Last Name:AREGULLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:OLIVER
Other - Last Name:AREGULLIN ELIGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 MICHIGAN ST NE STE 4200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-267-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112330207RA0002X, 207RI0011X, 2080P0202X
FL110254208000000X
TXU89392080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics