Healthcare Provider Details

I. General information

NPI: 1417879313
Provider Name (Legal Business Name): MICHAEL S RICHARDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 N COUNTY ROAD 25A
TROY OH
45373-1337
US

IV. Provider business mailing address

6628 CHARLESGATE RD
HUBER HEIGHTS OH
45424-7074
US

V. Phone/Fax

Practice location:
  • Phone: 210-834-5831
  • Fax:
Mailing address:
  • Phone: 210-834-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: