Healthcare Provider Details

I. General information

NPI: 1447637780
Provider Name (Legal Business Name): MEGHAN RICHLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

IV. Provider business mailing address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-6067
  • Fax:
Mailing address:
  • Phone: 337-261-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number320029
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: