Provider Demographics
NPI:1336228360
Name:RICHARD J HORBAL MD PC
Entity Type:Organization
Organization Name:RICHARD J HORBAL MD PC
Other - Org Name:MIDLAND ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HORBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-631-1010
Mailing Address - Street 1:555 W WACKERLY ST
Mailing Address - Street 2:SUITE 2675
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4722
Mailing Address - Country:US
Mailing Address - Phone:989-631-1010
Mailing Address - Fax:989-839-8800
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:SUITE 2675
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4722
Practice Address - Country:US
Practice Address - Phone:989-631-1010
Practice Address - Fax:989-839-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039488207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E61134OtherBCBSM
MI142136610Medicaid
MI1R00191OtherHEALTHPLUS OF MI
MI203484OtherMCLAREN HEALTH PLAN MI
MI0300900191OtherBCBSM
MI10505 30241OtherCOMMUNITY CHOICE OF MI
MI101348OtherGREAT LAKES HEALTH PLAN
MI0300900191OtherBLUE CARE NETWORK
DG8718OtherRR MEDICARE
MI142136610Medicaid
MI0P37710Medicare PIN
DG8718OtherRR MEDICARE
MI10505 30241OtherCOMMUNITY CHOICE OF MI