Healthcare Provider Details

I. General information

NPI: 1730292079
Provider Name (Legal Business Name): RICHARD A FICI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 E 12 MILE RD STE 300
ROSEVILLE MI
48066-6501
US

IV. Provider business mailing address

20905 E 12 MILE RD STE 300
ROSEVILLE MI
48066-6501
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-0727
  • Fax: 586-772-0640
Mailing address:
  • Phone: 586-772-0727
  • Fax: 586-772-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: