Provider Demographics
NPI:1861444796
Name:AMBROSE, RICHARD FRANCIS JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANCIS
Last Name:AMBROSE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16170 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9515
Mailing Address - Country:US
Mailing Address - Phone:517-263-0427
Mailing Address - Fax:
Practice Address - Street 1:415 MILL RD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1764
Practice Address - Country:US
Practice Address - Phone:734-425-4000
Practice Address - Fax:517-263-0427
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0001007213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT-34310Medicare UPIN
0812190002Medicare NSC