Provider Demographics
NPI:1134282122
Name:RICHARDS, MAUREEN S (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:S
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 W CRYSTAL LAKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4211
Mailing Address - Country:US
Mailing Address - Phone:815-363-8866
Mailing Address - Fax:815-363-8866
Practice Address - Street 1:4314 W CRYSTAL LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4211
Practice Address - Country:US
Practice Address - Phone:815-363-8866
Practice Address - Fax:815-363-8866
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-4266575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05600304OtherBCBS
IL05600304OtherBCBS
ILL84564Medicare PIN
ILE85266Medicare UPIN