1548328321 NPI number — MISS STACY KATHLEEN RICHARDS M.D.

Table of content: MISS STACY KATHLEEN RICHARDS M.D. (NPI 1548328321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548328321 NPI number — MISS STACY KATHLEEN RICHARDS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
STACY
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548328321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 N ROCHESTER RD
Provider Second Line Business Mailing Address:
SUITE100
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48306-4362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-650-1520
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 N ROCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48306-4362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-650-1520
Provider Business Practice Location Address Fax Number:
248-650-1530
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301053062 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08063294161 002 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2976080 TYPE 10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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