Healthcare Provider Details

I. General information

NPI: 1962582684
Provider Name (Legal Business Name): RICHARD CHARLES RELKEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PINE GROVE AVE
PORT HURON MI
48060-3511
US

IV. Provider business mailing address

1221 PINE GROVE AVE
PORT HURON MI
48060-3511
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-2663
  • Fax: 810-989-3174
Mailing address:
  • Phone: 810-985-2663
  • Fax: 810-989-3174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301026495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: