Provider Demographics
NPI:1609834977
Name:MAGGIORE, RONALD JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:MAGGIORE
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 1:400 GALLERIA OFFICENTRE STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2162
Mailing Address - Country:US
Mailing Address - Phone:877-227-8823
Mailing Address - Fax:
Practice Address - Street 1:2366 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:877-227-8823
Practice Address - Fax:313-578-6393
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48589207R00000X
IL036-124824207RG0300X, 207RH0003X
NY286694207RH0000X, 207RH0003X
CT045699207RH0000X
ORMD163132207RH0003X
MI4301506862207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04612057Medicaid