Healthcare Provider Details

I. General information

NPI: 1902116155
Provider Name (Legal Business Name): PATRICK D RICHMOND DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 MITCHELL PARK DR
PETOSKEY MI
49770-9600
US

IV. Provider business mailing address

PO BOX 525
PETOSKEY MI
49770-0525
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-3440
  • Fax: 231-347-4828
Mailing address:
  • Phone: 231-347-3440
  • Fax: 231-347-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPR001669
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPR001669
License Number StateMI

VIII. Authorized Official

Name: DR. PATRICK DENNIS RICHMOND
Title or Position: PRESIDENT
Credential: DPM
Phone: 231-347-3440