Basic Information
| Provider Information | |||||||||
| NPI: | 1669440467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 ARCH ST | ||||||||
| Address2: | STE. 1B | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753315 | ||||||||
| FaxNumber: | 3303753760 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 ARCH ST | ||||||||
| Address2: | STE. 1B | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753315 | ||||||||
| FaxNumber: | 3303753760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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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 | 207R00000X | 35-06-2456 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 729025 | 01 | OH | BUCKEYE COMMUNITY HEALTH | OTHER | 110095752 | 01 | OH | RAILROAD MEDICARE | OTHER | 143 | 01 | OH | SUMMA INSURANCE | OTHER | 0973460 | 05 | OH | MEDICAID | 000000132167 | 01 | OH | ANTHEM | OTHER | 0403110 | 01 | OH | UNITED HEALTHCARE | OTHER | 0753995 | 01 | OH | MEDICARE ID | OTHER |