MEDICARE: AMY L RICHTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085001863	IL

General Provider Information

NPI Number	:	1063463925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L RICHTER PA-C

Provider Business Mailing Address
First Line	:	22285 N PEPPER RD STE 103
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	224-357-8133
Fax Number	:	847-717-7313

Provider Business Practice Location Address
First Line	:	22285 N PEPPER RD STE 103
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	224-357-8133
Fax Number	:	847-717-7313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	12/07/2022

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