Healthcare Provider Details

I. General information

NPI: 1336228360
Provider Name (Legal Business Name): RICHARD J HORBAL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W WACKERLY ST SUITE 2675
MIDLAND MI
48640-4722
US

IV. Provider business mailing address

555 W WACKERLY ST SUITE 2675
MIDLAND MI
48640-4722
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-1010
  • Fax: 989-839-8800
Mailing address:
  • Phone: 989-631-1010
  • Fax: 989-839-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number4301039488
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD J HORBAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 989-631-1010