Provider Demographics
NPI:1831294727
Name:RICHTER, RALPH WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:WILLIAM
Last Name:RICHTER
Suffix:JR
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 1:4320 FIR STREET
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312
Mailing Address - Country:US
Mailing Address - Phone:219-392-1215
Mailing Address - Fax:219-392-0504
Practice Address - Street 1:4320 FIR STREET
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312
Practice Address - Country:US
Practice Address - Phone:219-392-1215
Practice Address - Fax:219-392-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040273A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100147320Medicaid
IN000000089192OtherBLUE CROSS BLUE SHIELD
IL90000287OtherBLUE CROSS BLUE SHIELD
F02932Medicare UPIN
IN0914270001Medicare NSC