Provider Demographics
NPI:1265463178
Name:NEEDLEMAN, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:NEEDLEMAN
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 1:28300 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FARMINGTON HILL
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-539-8630
Mailing Address - Fax:248-539-9045
Practice Address - Street 1:28300 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3704
Practice Address - Country:US
Practice Address - Phone:248-539-8630
Practice Address - Fax:248-539-9045
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087058207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RN087058OtherCOMMERCIAL-COMMERCIAL NUMBER
MI482180810Medicaid
700H262250OtherBLUE CROSS-BLUE CROSS
RN087058OtherCHAMPUS-CHAMPUS
RN087058OtherCOMMERCIAL-COMMERCIAL NUMBER
E34205Medicare UPIN
RN087058OtherCHAMPUS-CHAMPUS