Provider Demographics
NPI:1427408376
Name:ORLICH, RAQUEL (DO)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:ORLICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 ROSEMONT RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1845
Mailing Address - Country:US
Mailing Address - Phone:586-808-8909
Mailing Address - Fax:
Practice Address - Street 1:1620 MICHIGAN AVE STE 125
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1493
Practice Address - Country:US
Practice Address - Phone:313-444-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine