Provider Demographics
NPI:1427019157
Name:RICHMOND, MARTIN C (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:C
Last Name:RICHMOND
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 1:5435 FELTL RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7983
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:6401 FRANCE AVE S
Practice Address - Street 2:FAIRVIEW SOUTHDALE HOSPITAL
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-924-5141
Practice Address - Fax:952-924-5796
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27018207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27018OtherMEDICAL LICENSE
MN850377000Medicaid
MN27018OtherMEDICAL LICENSE
930000124Medicare ID - Type Unspecified