Provider Demographics
NPI:1265687024
Name:RICHARDS, MARCIA JS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:JS
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 1:675 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2556
Mailing Address - Country:US
Mailing Address - Phone:262-827-9888
Mailing Address - Fax:
Practice Address - Street 1:675 PARK CIR
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2556
Practice Address - Country:US
Practice Address - Phone:262-827-9888
Practice Address - Fax:262-827-9889
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI17780OtherWISCONSIN MEDICAL LICENSE
WIAR7369069OtherBNDD NUMBER
WI17780OtherWISCONSIN MEDICAL LICENSE