Provider Demographics
NPI:1891867131
Name:O. E. HORODYSKY, M.D., P.C.
Entity Type:Organization
Organization Name:O. E. HORODYSKY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OREST
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HORODYSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-371-5656
Mailing Address - Street 1:12206 MORANG
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224
Mailing Address - Country:US
Mailing Address - Phone:313-371-5656
Mailing Address - Fax:
Practice Address - Street 1:12206 MORANG
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224
Practice Address - Country:US
Practice Address - Phone:313-371-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI28607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103790910Medicaid
MI103790910Medicaid
B47125Medicare UPIN