Provider Demographics
NPI:1679511737
Name:HUMES, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:HUMES
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:UHC 5D MAILBOX 226 UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN BLVD -
Practice Address - Street 2:CHILDRENS HOSPITAL OF MICHIGAN 4TH FL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5082
Practice Address - Fax:313-993-0894
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010444292080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI301414410Medicaid
RH044429OtherCHAMPUS-CHAMPUS
RH044429OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262280OtherBLUE CROSS-BLUE CROSS
MI301414410Medicaid