Provider Demographics
NPI:1003111311
Name:ROBERT R RICHARDSON, MDSC
Entity Type:Organization
Organization Name:ROBERT R RICHARDSON, MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-839-1918
Mailing Address - Street 1:8426 BUCKINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1144
Mailing Address - Country:US
Mailing Address - Phone:708-839-1918
Mailing Address - Fax:
Practice Address - Street 1:1551 BOND ST
Practice Address - Street 2:143
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-0137
Practice Address - Country:US
Practice Address - Phone:630-983-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty