Provider Demographics
NPI:1275607632
Name:RICHTER, MARIE P (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:P
Last Name:RICHTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2202 HARLEM RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-654-5342
Practice Address - Street 1:2202 HARLEM RD STE 200
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2754
Practice Address - Country:US
Practice Address - Phone:815-877-4848
Practice Address - Fax:815-654-5342
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148817207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
390808509OtherCIGNA
32041400OtherHIRSP
690004890OtherMEDICARE RAILROAD
50072962OtherMEDICARE RAILROAD
90002361OtherWEA INS
WI32041400Medicaid
1015763OtherPHYSICIANS PLUS
390808509OtherCT GENERAL
12330OtherDEAN HEALTH PLAN
390808509OtherWPS
390808509OtherWPS
690004890OtherMEDICARE RAILROAD