Provider Demographics
NPI:1639101983
Name:RICHARD, GENE K (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:K
Last Name:RICHARD
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 1:2130 W CENTRAL AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3819
Mailing Address - Country:US
Mailing Address - Phone:419-534-3500
Mailing Address - Fax:419-534-2608
Practice Address - Street 1:2142 N. COVE BLVD
Practice Address - Street 2:PATHOLOGY LAB
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-534-3500
Practice Address - Fax:419-534-2608
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093525207ZP0102X
OH35.092325207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0894804Medicaid
OH0894804Medicaid
OH4249531Medicare PIN
OH0894804Medicaid
F33725Medicare UPIN
OHR14249531Medicare PIN
TX101433401Medicaid