Provider Demographics
NPI:1740233543
Name:RICHEY, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:RICHEY
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 1:537 ELMER RD
Mailing Address - Street 2:
Mailing Address - City:ELMER
Mailing Address - State:LA
Mailing Address - Zip Code:71424-9539
Mailing Address - Country:US
Mailing Address - Phone:318-659-4947
Mailing Address - Fax:
Practice Address - Street 1:7633 BELLAIRE DR S STE 117
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4311
Practice Address - Country:US
Practice Address - Phone:817-566-0663
Practice Address - Fax:817-346-2564
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09002R207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1924130Medicaid
LA1924130Medicaid
LA5N801CQ31Medicare ID - Type Unspecified