Provider Demographics
NPI:1598911521
Name:RICHTER, FEDERICO M (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:M
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 1:6050 STATE ROAD 70 E UNIT A
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9700
Mailing Address - Country:US
Mailing Address - Phone:941-907-3400
Mailing Address - Fax:941-907-4202
Practice Address - Street 1:6050 STATE ROAD 70 E UNIT A
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203
Practice Address - Country:US
Practice Address - Phone:941-907-3400
Practice Address - Fax:941-907-4202
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067389A207Q00000X
FLME122130202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000664470OtherANTHEM
IN200986100Medicaid
INM400019513Medicare PIN
INM400025686Medicare PIN
IN000000664470OtherANTHEM