Provider Demographics
NPI:1669440467
Name:RICH, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ARCH ST
Mailing Address - Street 2:STE. 1B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1423
Mailing Address - Country:US
Mailing Address - Phone:330-375-3315
Mailing Address - Fax:330-375-3760
Practice Address - Street 1:55 ARCH ST
Practice Address - Street 2:STE. 1B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1423
Practice Address - Country:US
Practice Address - Phone:330-375-3315
Practice Address - Fax:330-375-3760
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-2456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH729025OtherBUCKEYE COMMUNITY HEALTH
OH110095752OtherRAILROAD MEDICARE
OH143OtherSUMMA INSURANCE
OH0973460Medicaid
OH000000132167OtherANTHEM
OH0403110OtherUNITED HEALTHCARE
OH0753995OtherMEDICARE ID
OHF72308Medicare UPIN
OH0753993Medicare PIN
OH0753994Medicare PIN