Provider Demographics
NPI:1649269168
Name:HILL, RICHARD A (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:HILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 MEACHEM RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4662
Mailing Address - Country:US
Mailing Address - Phone:262-554-7004
Mailing Address - Fax:262-554-7833
Practice Address - Street 1:3500 MEACHEM RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4662
Practice Address - Country:US
Practice Address - Phone:262-554-7004
Practice Address - Fax:262-554-7833
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI423213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4388570002OtherDMERC #
WI43202800Medicaid
WI43202800Medicaid
WIT62212Medicare UPIN