Healthcare Provider Details

I. General information

NPI: 1427677384
Provider Name (Legal Business Name): SPENCER MICHAEL RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE RM F2-163
INDIANAPOLIS IN
46202-5187
US

IV. Provider business mailing address

1555 ESTATE DR
MEMPHIS TN
38119-6967
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-5835
  • Fax:
Mailing address:
  • Phone: 931-446-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1026612
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: