Provider Demographics
NPI:1033209556
Name:KING, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 485 UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-5411
Mailing Address - Fax:
Practice Address - Street 1:424 HARVARD STREET SE
Practice Address - Street 2:MASONIC CANCER CENTER, FIRST FLOOR, SUITE M100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1010343OtherPREFERRED ONE
MT0051753Medicaid
MN04-24506OtherMEDICA-CHOICE
MN04-00123OtherMEDICA-PRIMARY
MN101417OtherU CARE
IA0974022Medicaid
MN217578900Medicaid
MN089086OtherFAIRVIEW
MN2T154KIOtherBCBS
A96240Medicare UPIN
MT0051753Medicaid