Provider Demographics
NPI:1750362067
Name:DIGALO, JOSE PERALTA (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:PERALTA
Last Name:DIGALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:PERALTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43800 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:800-848-0202
Mailing Address - Fax:586-226-6949
Practice Address - Street 1:4150 RIVER RD
Practice Address - Street 2:
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-2915
Practice Address - Country:US
Practice Address - Phone:810-329-8870
Practice Address - Fax:810-329-6770
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032431207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1028901OtherECFMG
MI4516051Medicaid
MI4516051Medicaid
E10503Medicare UPIN