Provider Demographics
NPI:1588641633
Name:FOGEL, RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:FOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056430207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4630510Medicaid
N92430001Medicare ID - Type UnspecifiedMEDICARE NUMBER
MI4630510Medicaid