Provider Demographics
NPI:1033159132
Name:RICHTER, KENNETH J (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:RICHTER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:34505 WEST 12 MILE RD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331
Mailing Address - Country:US
Mailing Address - Phone:734-343-7500
Mailing Address - Fax:312-957-9991
Practice Address - Street 1:34505 WEST 12 MILE RD SUITE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331
Practice Address - Country:US
Practice Address - Phone:734-343-7500
Practice Address - Fax:312-957-9991
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007564208100000X, 2081P0004X, 2081P0010X, 2081P2900X, 2081S0010X, 208VP0000X, 208VP0014X, 204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2905041 TYPE 11Medicaid
MIP42800001Medicare PIN
MIA79943Medicare UPIN
MI2905041 TYPE 11Medicaid