Basic Information
| Provider Information | |||||||||
| NPI: | 1609834977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGGIORE | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 GALLERIA OFFICENTRE STE 400 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480342162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772278823 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2366 OAK VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772278823 | ||||||||
| FaxNumber: | 3135786393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 48589 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 036-124824 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RH0000X | 286694 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0000X | 045699 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0003X | 036-124824 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | MD163132 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 286694 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | 4301506862 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 04612057 | 05 | NY | MEDICAID |