Provider Demographics
NPI:1366639320
Name:DIGESTIVE HEALTH CENTERS OF MICHIGAN PC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH CENTERS OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-598-5731
Mailing Address - Street 1:30795 23 MILE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-5720
Mailing Address - Country:US
Mailing Address - Phone:586-598-5731
Mailing Address - Fax:586-948-1530
Practice Address - Street 1:30795 23 MILE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5720
Practice Address - Country:US
Practice Address - Phone:586-598-5731
Practice Address - Fax:586-948-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056430207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4630510Medicaid
MI0N92430Medicare PIN