Provider Demographics
NPI:1023292901
Name:W.J. RINGOLD M.D.P.C.
Entity type:Organization
Organization Name:W.J. RINGOLD M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-562-6607
Mailing Address - Street 1:2200 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3058
Mailing Address - Country:US
Mailing Address - Phone:313-562-6607
Mailing Address - Fax:313-562-5851
Practice Address - Street 1:2200 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3058
Practice Address - Country:US
Practice Address - Phone:313-562-9100
Practice Address - Fax:313-562-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB42901Medicare UPIN