MEDICARE: RICHARD B ATKINS MD PC

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	2084F0202X	Forensic Psychiatry Physician	RA057609	MI
2	2084P0804X	Child & Adolescent Psychiatry Physician	RA057609	MI
3	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	RA057609	MI
4	2084P0800X	Psychiatry Physician	RA057609	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2606350012	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1467647487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD B ATKINS MD PC

Provider Business Mailing Address
First Line	:	2300 HAGGERTY RD
Second Line	:	SUITE 2160
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2192
Country	:	US
Telephone Number	:	248-960-5106
Fax Number	:	248-960-5532

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY RD
Second Line	:	SUITE 2160
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2192
Country	:	US
Telephone Number	:	248-960-5106
Fax Number	:	248-960-5532

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD B ATKINS
Credential	:	MD
Telephone Number	:	248-960-5106

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/12/2007

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