Healthcare Provider Details

I. General information

NPI: 1689755084
Provider Name (Legal Business Name): TANISHA RENEE RICHMOND, DPM DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 3RD ST
DAYTON OH
45402-6714
US

IV. Provider business mailing address

1323 W 3RD ST
DAYTON OH
45402-6714
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-3668
  • Fax: 937-228-3660
Mailing address:
  • Phone: 937-228-3668
  • Fax: 937-228-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-003457
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: