Provider Demographics
NPI:1548244619
Name:HORBAL, RICHARD J (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:HORBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W WACKERLY ST
Mailing Address - Street 2:SUITE 2675
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4722
Mailing Address - Country:US
Mailing Address - Phone:989-631-1010
Mailing Address - Fax:
Practice Address - Street 1:414 N TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-895-5007
Practice Address - Fax:989-895-8032
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039488174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10138OtherGREAT LAKES HEALTH PLAN
MI1100900191OtherHEALTH PLUS OF MI
MI1433385 10Medicaid
MI1421366 10Medicaid
MI0300900191OtherBCBSM
MIA76438Medicare UPIN
MI1421366 10Medicaid
MI110063220Medicare PIN
MI0300900191OtherBCBSM