Healthcare Provider Details

I. General information

NPI: 1326072489
Provider Name (Legal Business Name): DANIEL L RICHARDSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
EATON RAPIDS MI
48827-1952
US

IV. Provider business mailing address

PO BOX 634087
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 517-663-2671
  • Fax:
Mailing address:
  • Phone: 800-540-8739
  • Fax: 616-975-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberDR010322
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: