Provider Demographics
NPI:1891738035
Name:RICHMOND, DEBORAH L (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3900
Mailing Address - Fax:517-913-3901
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 201
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3900
Practice Address - Fax:517-913-3901
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001922OtherMCLAREN HEALTH PLAN-MEDICAID
MI110169069OtherRAILROAD MEDICARE
MI200000002615OtherPHP
MI200000002615OtherPHP FAMILYCARE
MI1001922OtherMCLAREN HEALTH ADVANTAGE
MI1001922OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1153302355OtherBCBS/BCN
MI4079724Medicaid
MI0M21440003OtherMEDICARE ADVANTAGE
MI4452199OtherAETNA
MI4857079Medicaid
MI0M21440003OtherMEDICARE ADVANTAGE
MI4452199OtherAETNA