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General NPI Number Information
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NPI Number | 1417879313
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Entity Type | Individual
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Provider Name | MICHAEL S RICHARDSON
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Gender | Male
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 3130 N COUNTY ROAD 25A
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City | TROY
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State | OH
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Zip | 45373-1337
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Country | US
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Telephone | 210-834-5831
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Fax |
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Provider Business Mailing Address
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Address Line | 6628 CHARLESGATE RD
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-7074
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Country | US
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Telephone | 210-834-5831
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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