Provider Demographics
NPI:1740630391
Name:RICHARDSON, MICHAEL TODD (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TODD
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-1009
Practice Address - Country:US
Practice Address - Phone:608-263-0946
Practice Address - Fax:608-263-9103
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2021-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA083164363AM0700X
WI4025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical