Provider Demographics
NPI:1336313196
Name:RICHESIN, SAMUEL DOUGLAS II (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DOUGLAS
Last Name:RICHESIN
Suffix:II
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 1:2685 XANTHIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2550
Mailing Address - Country:US
Mailing Address - Phone:720-454-2220
Mailing Address - Fax:
Practice Address - Street 1:501 28TH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3003
Practice Address - Country:US
Practice Address - Phone:303-602-6333
Practice Address - Fax:303-436-4610
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine