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General NPI Number Information
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NPI Number | 1366639320
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH CENTERS OF MICHIGAN PC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 30795 23 MILE RD SUITE 206
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5720
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Country | US
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Telephone | 586-598-5731
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Fax | 586-948-1530
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Provider Business Mailing Address
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Address Line | 30795 23 MILE RD SUITE 206
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5720
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Country | US
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Telephone | 586-598-5731
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Fax | 586-948-1530
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Authorized Official
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Title or Position | PHYSICAN/OWNER
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Name | DR. RONALD P FOGEL
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Credential | M.D.
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Telephone | 586-598-5731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301056430
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License Number State | MI
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