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NPI Code Detail

MEDICARE: COBY T RICHESON MD

MEDICARE: COBY T RICHESON MD
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
1207R00000XInternal Medicine Physician01053052AIN
2208000000XPediatrics Physician01053052AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000244563OTHERINANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700835204
Entity Type Code : Individual
Provider Name (Legal Business Name) : COBY T RICHESON MD
Provider Business Mailing Address
First Line : 10421 E COUNTY ROAD 100 N
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46234-1243
Country : US
Telephone Number : 317-272-7013
Fax Number : 317-272-7007
Provider Business Practice Location Address
First Line : 10421 E COUNTY ROAD 100 N
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46234-1243
Country : US
Telephone Number : 317-272-7013
Fax Number : 317-272-7007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 03/29/2021

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Directions to “ COBY T RICHESON MD” Practice Location

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