Provider Demographics
NPI:1568467371
Name:FERRARA, RICHARD JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:FERRARA
Suffix:JR
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 1:20045 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2322
Mailing Address - Country:US
Mailing Address - Phone:313-884-5100
Mailing Address - Fax:313-884-9446
Practice Address - Street 1:20045 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2322
Practice Address - Country:US
Practice Address - Phone:313-884-5100
Practice Address - Fax:313-884-9446
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2021-10-26
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
MI4301057129207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102774745Medicaid
MI102774745Medicaid
MI0827002Medicare ID - Type Unspecified