Healthcare Provider Details

I. General information

NPI: 1427435320
Provider Name (Legal Business Name): ABIGAIL RICHESON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E CENTRE AVE
PORTAGE MI
49002-5500
US

IV. Provider business mailing address

601 JOHN STREET BOX 39
KALAMAZOO MI
49007
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101021599
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: