Healthcare Provider Details

I. General information

NPI: 1659456523
Provider Name (Legal Business Name): MARK H RICHTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 HIGHLAND RD #106
WHITE LK MI
48386
US

IV. Provider business mailing address

8355 HIGHLAND RD
WHITE LAKE MI
48386-4618
US

V. Phone/Fax

Practice location:
  • Phone: 248-666-6005
  • Fax: 248-666-6669
Mailing address:
  • Phone: 248-666-6005
  • Fax: 248-666-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMR053494
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: