Provider Demographics
NPI:1609802503
Name:RICHES, HAROLD KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:KENNETH
Last Name:RICHES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1541
Mailing Address - Country:US
Mailing Address - Phone:414-545-1120
Mailing Address - Fax:414-545-2505
Practice Address - Street 1:9305 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1541
Practice Address - Country:US
Practice Address - Phone:414-545-1120
Practice Address - Fax:414-545-2505
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO21822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39130061011OtherBLUE CROSS
WI30011000Medicaid