Provider Demographics
NPI:1457425688
Name:RICHARD J HORBAL MD PC
Entity Type:Organization
Organization Name:RICHARD J HORBAL MD PC
Other - Org Name:BAY 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:989-895-5007
Mailing Address - Street 1:414 N TUSCOLA RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6962
Mailing Address - Country:US
Mailing Address - Phone:989-895-5007
Mailing Address - Fax:989-895-8032
Practice Address - Street 1:414 N TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6962
Practice Address - Country:US
Practice Address - Phone:989-895-5007
Practice Address - Fax:989-895-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
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
MI1100900191OtherHEALTHPLUS
MI030Z91175OtherBCBSM GROUP PIN
MIDG8718OtherRR MEDICARE
MI1433385 10Medicaid
MI0300900191OtherBCBSM
MI=========OtherCOMMERCIAL
MIA76438Medicare UPIN
MI0300900191OtherBCBSM
MI=========OtherCOMMERCIAL