Healthcare Provider Details

I. General information

NPI: 1699736611
Provider Name (Legal Business Name): LAWRENCE B. RICHARD, D.P.M., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22908 WICK RD SUITE C
TAYLOR MI
48180-3589
US

IV. Provider business mailing address

22908 WICK RD SUITE C
TAYLOR MI
48180-3589
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-2660
  • Fax: 313-295-2661
Mailing address:
  • Phone: 313-295-2660
  • Fax: 313-295-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE B RICHARD
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 313-295-2660