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General NPI Number Information
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NPI Number | 1811009970
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Entity Type | Individual
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Provider Name | RICHARD GORDON PICHA DPM
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 1919 UNIVERSITY AVE W STE TLC
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City | SAINT PAUL
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State | MN
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Zip | 55104-3453
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Country | US
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Telephone | 952-926-6670
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Fax |
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Provider Business Mailing Address
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Address Line | 6015 PARK AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-3123
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Country | US
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Telephone | 952-926-6670
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 288
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License Number State | MN
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