Healthcare Provider Details

I. General information

NPI: 1689930612
Provider Name (Legal Business Name): ROBERT L RICHMOND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 MCHENRY ST
BURLINGTON WI
53105-1828
US

IV. Provider business mailing address

248 MCHENRY ST
BURLINGTON WI
53105-1828
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-8094
  • Fax:
Mailing address:
  • Phone: 262-767-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number62020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number62020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: