Your M.d., S.c.

NPI 1255724597 - Family Medicine - 207Q00000X

NPI Details
NPI 1255724597
Enumeration Date 03/11/2015
Last Updated 05/04/2015
Entity Type Healthcare Provider
Active Over 1 year ago
Authorized Information
Name RICHARD RICHARD
Position PHYSICIAN/PRESIDENT
Phone (262) 226-8899
Fax (262) 226-8899
Practice Location
11649 N PORT WASHINGTON RD
SUITE 114
MEQUON WI, 53092-3460, US
Phone (262) 226-8899
Fax (262) 226-8899
Business Location
9706 N VALLEY HILL DR
MEQUON WI, 53092-5341, US
Phone (262) 643-4546
Fax (262) 226-8899
Toxanomy
Taxonomy Code 207Q00000X
License State Wisconsin
License Number 36985-20
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According to our database, Your M.d., S.c. NPI is 1255724597, taxonomy code is 207Q00000X and license number is 36985-20, license state is located at Wisconsin. Your M.d., S.c. physically located at 11649 N Port Washington Rd, Mequon WI, 53092-3460. NPI Number 1033115704 has the healthcare provider type.

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1255724597 NPI number is provided on an as is basis without warranty of any kind. 1255724597 is maintained by the National Plan & Provider Enumeration System. The contents of Your M.d., S.c. are for informational purposes only.