Provider Demographics
NPI:1851389100
Name:RICHMOND, PATRICK DENNIS (DPM)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DENNIS
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-0525
Mailing Address - Country:US
Mailing Address - Phone:231-347-3440
Mailing Address - Fax:231-347-4828
Practice Address - Street 1:2233 MITCHELL PARK DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9600
Practice Address - Country:US
Practice Address - Phone:231-347-3440
Practice Address - Fax:231-347-4828
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001669213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR001669OtherPRIORITY
MI4852450310OtherBCBSM
MIPR001669OtherBCBSM
1310710002Medicare NSC
MI480033381Medicare PIN
MI4852450310OtherBCBSM
1310710001Medicare NSC
MI480015864Medicare PIN
MIPR001669OtherBCBSM