Provider Demographics
NPI:1770675274
Name:RICHARD, JAMES EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:RICHARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPT 77972
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0972
Mailing Address - Country:US
Mailing Address - Phone:517-372-5520
Mailing Address - Fax:517-372-5540
Practice Address - Street 1:2508 SOUTH CEDAR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-372-5520
Practice Address - Fax:517-372-5540
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011238207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM33540005Medicare ID - Type Unspecified
E82669Medicare UPIN