Provider Demographics
NPI:1164428371
Name:RICHEY, KARL E (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:E
Last Name:RICHEY
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 1:161 HALONA ST
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8523
Mailing Address - Country:US
Mailing Address - Phone:808-268-8517
Mailing Address - Fax:808-891-8279
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-225-5171
Practice Address - Fax:907-228-8333
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11527208D00000X
WAMD34402207P00000X
AK2644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD34402OtherSTATE MEDICAL LICENSE
AK2644OtherSTATE MEDICAL LICENSE
HIA52433Medicare UPIN
HI55413Medicare ID - Type Unspecified