Basic Information
Provider Information | |||||||||
NPI: | 1689662405 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOWELL | ||||||||
FirstName: | RICHARD | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 370 N 120TH AVE | ||||||||
Address2: |   | ||||||||
City: | HOLLAND | ||||||||
State: | MI | ||||||||
PostalCode: | 494242196 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6163965855 | ||||||||
FaxNumber: | 6163965720 | ||||||||
Practice Location | |||||||||
Address1: | 370 N 120TH AVE | ||||||||
Address2: |   | ||||||||
City: | HOLLAND | ||||||||
State: | MI | ||||||||
PostalCode: | 494242196 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6163965855 | ||||||||
FaxNumber: | 6163965720 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2005 | ||||||||
LastUpdateDate: | 07/29/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0105X | 4301082987 | MI | Y |   | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | 207XX0005X | 4301082987 | MI | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | RH082987 | 01 | MI | BCBS LICENSE | OTHER | 4893870 | 05 | MI |   | MEDICAID |