Provider Demographics
NPI:1659454478
Name:RICHARDS, JOANNE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MICHELLE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 35TH AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5424
Mailing Address - Country:US
Mailing Address - Phone:954-961-7718
Mailing Address - Fax:954-961-0163
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-961-7718
Practice Address - Fax:954-961-0163
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68319207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379460100Medicaid
FL27516Medicare ID - Type Unspecified