Provider Demographics
NPI:1275587727
Name:PLUMMER, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:RUSH UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:1653 W CONGRESS PARKWAY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3800
Mailing Address - Country:US
Mailing Address - Phone:605-215-2185
Mailing Address - Fax:605-653-3226
Practice Address - Street 1:RUSH UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:1653 W CONGRESS PARKWAY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3800
Practice Address - Country:US
Practice Address - Phone:605-215-2185
Practice Address - Fax:605-653-3226
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD10564207Q00000X
SD1119207Q00000X
IL036.147372207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3971770Medicaid
MN882068600Medicaid
SD1256OtherAVERA
SD1565OtherMIDLANDS CHOICE
SD5602648Medicaid
SD1119OtherDAKOTACARE
SDAH1801016438OtherPREFERRED ONE
SD28190OtherSANFORD HEALTH PLANS
SD4993464OtherBLUE CROSS BLUE SHIELD
SDP00397642OtherRAILROAD MEDICARE
SD1565OtherMIDLANDS CHOICE