Provider Demographics
NPI:1871563130
Name:GARGULINSKI, RICHARD B (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:GARGULINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28595 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2977
Mailing Address - Country:US
Mailing Address - Phone:248-553-0010
Mailing Address - Fax:248-553-0818
Practice Address - Street 1:28595 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2977
Practice Address - Country:US
Practice Address - Phone:248-553-0010
Practice Address - Fax:248-553-0818
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0107522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2942831Medicaid
MIG58006Medicare UPIN
MI56328297131Medicare ID - Type Unspecified