Healthcare Provider Details

I. General information

NPI: 1295771947
Provider Name (Legal Business Name): RICHARD A FLANAGAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 ELLIOTT DR SUITE 104
YPSILANTI MI
48197-8633
US

IV. Provider business mailing address

5325 ELLIOTT DR SUITE 104
YPSILANTI MI
48197-8633
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8150
  • Fax: 734-712-8151
Mailing address:
  • Phone: 734-712-8150
  • Fax: 734-712-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301057490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: