MEDICARE: BRENT E RICHARDSON 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
1	207Y00000X	Otolaryngology Physician	036092502	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1942399225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT E RICHARDSON MD

Provider Business Mailing Address
First Line	:	3010 HIGHLAND PKWY STE 250
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-5545
Country	:	US
Telephone Number	:	630-724-1100
Fax Number	:	630-724-0084

Provider Business Practice Location Address
First Line	:	3010 HIGHLAND PKWY STE 250
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-5545
Country	:	US
Telephone Number	:	630-724-1100
Fax Number	:	630-724-0084

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/14/2025

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Directions to “ BRENT E RICHARDSON MD” Practice Location

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