Basic Information
| Provider Information | |||||||||
| NPI: | 1003013657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPINALE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 INKSTER RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481352577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344276570 | ||||||||
| FaxNumber: | 7344276140 | ||||||||
| Practice Location | |||||||||
| Address1: | 6255 INKSTER RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481352577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344276570 | ||||||||
| FaxNumber: | 7344276140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 009110 | MI | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2842362 | 05 | MI | MEDICAID |