Basic Information
| Provider Information | |||||||||
| NPI: | 1598791766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 N STATE ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HARRISVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487409255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897245655 | ||||||||
| FaxNumber: | 9893583730 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 N STATE ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HARRISVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487409255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897245655 | ||||||||
| FaxNumber: | 9893583730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301049031 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2888245 | 05 | MI | MEDICAID |