Healthcare Provider Details

I. General information

NPI: 1427019157
Provider Name (Legal Business Name): MARTIN C RICHMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVE S FAIRVIEW SOUTHDALE HOSPITAL
EDINA MN
55435
US

IV. Provider business mailing address

5435 FELTL RD
MINNETONKA MN
55343-7983
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-5141
  • Fax: 952-924-5796
Mailing address:
  • Phone: 952-835-9880
  • Fax: 952-857-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27018
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: