Provider Demographics
NPI:1073500237
Name:RICHARDS, KATHLEEN (DPM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11046 N SAGUARO BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-5537
Mailing Address - Country:US
Mailing Address - Phone:480-837-2240
Mailing Address - Fax:480-836-8566
Practice Address - Street 1:11046 N SAGUARO BLVD
Practice Address - Street 2:STE 2
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-5537
Practice Address - Country:US
Practice Address - Phone:480-837-2240
Practice Address - Fax:480-836-8566
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ392213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z0413OtherHEALTH NET
AZ001233945Medicaid
AZAZ0193680OtherBCBS
AZ4757050001Medicare NSC
AZ27928Medicare PIN
AZ001233945Medicaid