MEDICARE: LISA M RICHTER D.O.

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	207Q00000X	Family Medicine Physician	02002515A	IN

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
2	P01456957	OTHER	IN	RAIL ROAD PTAN
3	000000228239	OTHER	IN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306842414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M RICHTER D.O.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	STE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:	317-621-7584
Fax Number	:	317-957-2705

Provider Business Practice Location Address
First Line	:	55 BRENDON WAY STE 100
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1955
Country	:	US
Telephone Number	:	317-957-9150
Fax Number	:	317-957-9965

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/28/2025

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