Provider Demographics
NPI:1922114750
Name:RICHARDSON, ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:331 S 36TH STREET SUITE 6
Mailing Address - Street 2:KNAPHEIDE FAMILY WELLNESS CEN
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-214-0243
Mailing Address - Fax:217-214-0244
Practice Address - Street 1:331 S 36TH STREET SUITE 6
Practice Address - Street 2:KNAPHEIDE FAMILY WELLNESS CEN
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-214-0243
Practice Address - Fax:217-214-0244
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-098572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22149Medicare PIN