Provider Demographics
NPI:1356769111
Name:RICHARD, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:RICHARD
Suffix:
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 1:150 KENDALL ST S
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-8471
Mailing Address - Country:US
Mailing Address - Phone:269-441-4141
Mailing Address - Fax:269-441-4142
Practice Address - Street 1:150 KENDALL ST S
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-8471
Practice Address - Country:US
Practice Address - Phone:269-441-4141
Practice Address - Fax:269-441-4142
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053532207P00000X
HIMD-17111208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice