Provider Demographics
NPI:1508866351
Name:RICHARDS, MELVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:J
Last Name:RICHARDS
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 1:615 VALLEY VIEW DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6180
Mailing Address - Country:US
Mailing Address - Phone:309-762-1072
Mailing Address - Fax:309-762-1094
Practice Address - Street 1:615 VALLEY VIEW DR.
Practice Address - Street 2:SUITE 202
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6180
Practice Address - Country:US
Practice Address - Phone:309-762-1072
Practice Address - Fax:309-762-1094
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0458922085R0202X
IA174972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7916924Medicaid
IA9916924Medicaid
IA5916924Medicaid
IL95101OtherWELLMARK
IA20144OtherIA HEALTH SOLUTIONS
IA47823OtherWELLMARK
IA1576694Medicaid
IA2576694Medicaid
IA3576694Medicaid
IL036045892Medicaid
IL97671OtherWELLMARK
IA0576694Medicaid
IA4916924Medicaid
IA8916924Medicaid
IA4916924Medicaid
300016119Medicare PIN
IA9916924Medicaid
IA20144OtherIA HEALTH SOLUTIONS
C37251Medicare UPIN