Provider Demographics
NPI:1659456523
Name:RICHTER, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
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 1:8355 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-4618
Mailing Address - Country:US
Mailing Address - Phone:248-666-6005
Mailing Address - Fax:248-666-6669
Practice Address - Street 1:8355 HIGHLAND RD #106
Practice Address - Street 2:
Practice Address - City:WHITE LK
Practice Address - State:MI
Practice Address - Zip Code:48386
Practice Address - Country:US
Practice Address - Phone:248-666-6005
Practice Address - Fax:248-666-6669
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR053494208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4408493Medicaid
080186543OtherRR MEDICARE
080F32255OtherBCBS
383637981OtherTAX ID COMMERCIAL
0994309OtherHEALTH PLUS
4130452OtherAETHA
MI0N93160Medicare ID - Type Unspecified
MI4408493Medicaid