Provider Demographics
NPI:1194962530
Name:MORTENSEN, RICHARD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:MORTENSEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1301 CATHERINE ST
Mailing Address - Street 2:7641 MEDICAL SCIENCES II
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2026
Mailing Address - Country:US
Mailing Address - Phone:734-763-2021
Mailing Address - Fax:734-936-8813
Practice Address - Street 1:1301 CATHERINE ST
Practice Address - Street 2:7641 MEDICAL SCIENCES II
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2026
Practice Address - Country:US
Practice Address - Phone:734-763-2021
Practice Address - Fax:734-936-8813
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301079053207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism