Provider Demographics
NPI:1346700333
Name:RICHTER, DUSTIN JON (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JON
Last Name:RICHTER
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 1:8701 W. WATERTOWN PLANK ROAD
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY MCW - HUB
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-955-3212
Mailing Address - Fax:
Practice Address - Street 1:8701 W. WATERTOWN PLANK ROAD
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY MCW - HUB
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-955-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program