Provider Demographics
NPI:1699736611
Name:LAWRENCE B. RICHARD, D.P.M., P.L.L.C.
Entity type:Organization
Organization Name:LAWRENCE B. RICHARD, D.P.M., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-295-2660
Mailing Address - Street 1:22908 WICK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3589
Mailing Address - Country:US
Mailing Address - Phone:313-295-2660
Mailing Address - Fax:313-295-2661
Practice Address - Street 1:22908 WICK RD
Practice Address - Street 2:SUITE C
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3589
Practice Address - Country:US
Practice Address - Phone:313-295-2660
Practice Address - Fax:313-295-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT91553Medicare UPIN
MI1186930001Medicare NSC
MI0MI1316001Medicare PIN