Provider Demographics
NPI:1730143850
Name:RICHARDSON, KURT ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALLEN
Last Name:RICHARDSON
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 1:6294 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2553
Mailing Address - Country:US
Mailing Address - Phone:517-282-6453
Mailing Address - Fax:
Practice Address - Street 1:6294 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:BURTCHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48059-2553
Practice Address - Country:US
Practice Address - Phone:517-282-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3355500Medicaid
MI3355500Medicaid
MIM43590004Medicare ID - Type UnspecifiedMEDICARE