Provider Demographics
NPI:1073771150
Name:CLIFFORD, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:CLIFFORD
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 1:17665 W. WISCONSIN AVE.
Mailing Address - Street 2:UNIT B
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:262-395-4278
Mailing Address - Fax:414-476-1496
Practice Address - Street 1:2350 N MET TO WEE LN
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1613
Practice Address - Country:US
Practice Address - Phone:414-476-6304
Practice Address - Fax:414-476-1496
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14673-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology