Provider Demographics
NPI:1124234430
Name:RICHARDSON, ARLENE JAMELLE (MD)
Entity type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:JAMELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E SOUTH WATER ST
Mailing Address - Street 2:APT. 1709
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4021
Mailing Address - Country:US
Mailing Address - Phone:901-830-3877
Mailing Address - Fax:
Practice Address - Street 1:71 W 156TH ST STE 110
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4267
Practice Address - Country:US
Practice Address - Phone:708-915-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336091782282N00000X
KY462922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No282N00000XHospitalsGeneral Acute Care Hospital