Healthcare Provider Details

I. General information

NPI: 1982818571
Provider Name (Legal Business Name): RICHARD A JOSEPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 MORVEN COURT
NAPERVILLE IL
60563
US

IV. Provider business mailing address

828 MORVEN COURT
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 630-717-8200
  • Fax:
Mailing address:
  • Phone: 630-717-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036050934
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036050934
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: