MEDICARE: RISHI DUGGAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	4301091368	MI

General Provider Information

NPI Number	:	1821392820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RISHI DUGGAL M.D.

Provider Business Mailing Address
First Line	:	1920 AVENUE ROAD
Second Line	:
City	:	BRIGHT'S GROVE
State	:	ONTARIO
Zip	:	N0N1C0
Country	:	CA
Telephone Number	:	519-908-9129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 PINE GROVE AVE
Second Line	:	SUITE 7
City	:	PORT HURON
State	:	MI
Zip	:	48060-3370
Country	:	US
Telephone Number	:	810-985-0029
Fax Number	:	810-985-0032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/05/2011

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