Provider Demographics
NPI:1780025619
Name:RICHLEY, DOUGLAS MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARK
Last Name:RICHLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-0378
Mailing Address - Country:US
Mailing Address - Phone:231-299-8900
Mailing Address - Fax:231-887-4320
Practice Address - Street 1:315 OAKGROVE ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1176
Practice Address - Country:US
Practice Address - Phone:231-299-8900
Practice Address - Fax:231-887-4320
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013023332207N00000X
MI5101022086207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology