Provider Demographics
NPI:1609862374
Name:SENN, RICHARD T I (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:SENN
Suffix:I
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:PO BOX 6087
Mailing Address - Street 2:113 WEST SOUTHWAY BLVD
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46904-6087
Mailing Address - Country:US
Mailing Address - Phone:765-453-4654
Mailing Address - Fax:765-455-2266
Practice Address - Street 1:113 W SOUTHWAY BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3653
Practice Address - Country:US
Practice Address - Phone:765-453-4654
Practice Address - Fax:765-455-2266
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023507208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100136470Medicaid
IN363210AMedicare ID - Type Unspecified
D69574Medicare UPIN