Ralph J Tidalgo, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301045963 Issued in MI

Practice address

26645 W 12 Mile Rd
Ste 109
Southfield, MI 48034-7811

Phone

(248) 797-5293

Fax

(248) 327-7394

NPI assigned

Aug 30, 2006

Last updated

Jan 1, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Laz Medical Group PC

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Southfield, MI
  • NPI 1053310128
  Medicare reassignment NPD
• Vitality Visiting Physicians, PLLC

  • General Practice Physician
  • Garden City, MI
  • NPI 1073230876
  Medicare reassignment NPD
• Davicare Home Medical Services PC

  • Internal Medicine Physician
  • Bloomfield Hills, MI
  • NPI 1033287966
  NPD (past)
• Health Centers Detroit Foundation, Inc.

  dba Health Centers Detroit MedicalGroup

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1518026541
  NPD (past)
• Infinity Visiting Physician Services PLC

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1437572930
  NPD (past)
• New Image Home Medical Equipment Inc.

  • Durable Medical Equipment & Medical Supplies
  • Southfield, MI
  • NPI 1154495398
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483228800000",
    "number": "1427168525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4889 OLD POST CT",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013554",
            "telephone_number": "248-320-6409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26645 W 12 MILE RD",
            "address_2": "STE 109",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347811",
            "telephone_number": "248-797-5293",
            "fax_number": "248-327-7394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDALGO",
        "first_name": "RALPH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301045963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4284823",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deangela Thurmond
• Amber Thweni
• Karen Pierce Tibbs, OTR/L
• Ajai Tice
• Sharon Lee Tice, MD
• Tierracare LLC
• Tiffany M. Boards (Peace of Mind Child & Family Psychological Services)
• Judith Harriet Tigay, FNP-BC
• Cassandra Joyce Tigner
• Galina Tikh, M.D.

• Internal Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.