MEDICARE: DR. MARK ALAN RICHMOND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301058393	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144227653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN RICHMOND MD

Provider Business Mailing Address
First Line	:	2810 CHARLEVOIX AVE,
Second Line	:	SUITE 104
City	:	PETOSKEY
State	:	MI
Zip	:	49770
Country	:	US
Telephone Number	:	231-881-9054
Fax Number	:	231-881-9052

Provider Business Practice Location Address
First Line	:	2810 CHARLEVOIX AVE
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770
Country	:	US
Telephone Number	:	231-881-9054
Fax Number	:	231-881-9052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	01/23/2025

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