Provider Demographics
NPI:1720166648
Name:YORK, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:YORK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 N ATKINSON DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2918
Mailing Address - Country:US
Mailing Address - Phone:231-845-7732
Mailing Address - Fax:231-843-1190
Practice Address - Street 1:5 N ATKINSON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2918
Practice Address - Country:US
Practice Address - Phone:231-845-7732
Practice Address - Fax:231-843-1190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRY046032208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22971OtherPRIORITY HEALTH
MI020033763OtherRAILROAD RETIREMENT
MI103141OtherMOLINA
MI3359680Medicaid
MI0205344932OtherBLUE CROSS BLUE SHIELD
MI3359680Medicaid
F04694Medicare UPIN