Provider Demographics
NPI:1629056866
Name:SCOLARI, RALPH DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DAVID
Last Name:SCOLARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR ROAD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING SERVICES
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:15855 NINETEEN MILE ROAD
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3504
Practice Address - Country:US
Practice Address - Phone:586-263-2601
Practice Address - Fax:586-263-2589
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012896207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11-4221823Medicaid
MI11-4221799Medicaid
MI11-4586190Medicaid
MI11-4221832Medicaid
MI0158208095OtherBCBS
MI11-4221734Medicaid
MI11-4221841Medicaid
MI11-4221860Medicaid
MI11-4221805Medicaid
MI11-4221879Medicaid
MIQ26294287Medicare ID - Type UnspecifiedPEC OKW
MIN87430024Medicare UPIN
MI11-4221879Medicaid
MI11-4586190Medicaid
MI11-4221832Medicaid