Provider Demographics
NPI:1982606877
Name:GIRARDI, RICHARD G (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:GIRARDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 KIMOLE LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1478
Mailing Address - Country:US
Mailing Address - Phone:517-263-6464
Mailing Address - Fax:517-263-8223
Practice Address - Street 1:777 KIMOLE LN
Practice Address - Street 2:SUITE 220
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1478
Practice Address - Country:US
Practice Address - Phone:517-263-6464
Practice Address - Fax:517-263-8223
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000359501OtherANTHEM
MI0254620994OtherBCBS MI
MI115543OtherPREFERRED CHOICE PPO
MI4516021OtherAETNA
100975OtherGLHP
MI03641OtherPARAMOUNT
MI115543OtherCARE CHOICES
OH2645347Medicaid
MI4547844Medicaid
MIP00123694OtherRRMC
MI03641OtherPARAMOUNT
MI4547844Medicaid
MI0254620994OtherBCBS MI
MIF09380Medicare UPIN