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General NPI Number Information
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NPI Number | 1376004424
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Entity Type | Individual
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Provider Name | MICAH ROSE RICHARDSON MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1611 W HARRISON ST STE 400
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City | CHICAGO
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State | IL
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Zip | 60612-4861
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Country | US
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Telephone | 877-632-6637
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Fax | 708-409-5179
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Provider Business Mailing Address
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Address Line | PO BOX 735263
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City | CHICAGO
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State | IL
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Zip | 60673-5263
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Country | US
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Telephone | 877-632-6637
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Fax | 708-409-5179
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD478807
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01095627A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 036173831
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 01095627A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT217723
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036173831
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License Number State | IL
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