Healthcare Provider Details

I. General information

NPI: 1598963605
Provider Name (Legal Business Name): RICHARD S YORK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N ATKINSON DR STE 201
LUDINGTON MI
49431-2918
US

IV. Provider business mailing address

5 N ATKINSON DR STE 201
LUDINGTON MI
49431-2918
US

V. Phone/Fax

Practice location:
  • Phone: 231-845-7732
  • Fax: 231-843-1190
Mailing address:
  • Phone: 231-845-7732
  • Fax: 231-843-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRY046032
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCY144138
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD YORK
Title or Position: PRESIDENT
Credential: MD
Phone: 231-845-7732