Provider Demographics
NPI:1306352877
Name:DANDY, RICHARD JAMES (CPRM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:DANDY
Suffix:
Gender:M
Credentials:CPRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9044 LA SALLE BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2021
Mailing Address - Country:US
Mailing Address - Phone:313-894-7400
Mailing Address - Fax:313-894-7460
Practice Address - Street 1:9044 LA SALLE BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2021
Practice Address - Country:US
Practice Address - Phone:313-651-6688
Practice Address - Fax:313-894-7460
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM-00114175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist