Provider Demographics
NPI:1215938592
Name:ANNINGSON, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:ANNINGSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E 7TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2535
Mailing Address - Country:US
Mailing Address - Phone:260-927-8105
Mailing Address - Fax:260-927-8026
Practice Address - Street 1:1314 E 7TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2535
Practice Address - Country:US
Practice Address - Phone:260-925-5511
Practice Address - Fax:260-925-8353
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039769A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000081119OtherANTHEM
IN1035OtherPHYSICIANS HEALTH PLAN
INF35094Medicare UPIN
IN191560EMedicare ID - Type Unspecified