Provider Demographics
NPI:1902821671
Name:PITTSLEY, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:PITTSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 E LANSING DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7787
Mailing Address - Country:US
Mailing Address - Phone:517-351-8881
Mailing Address - Fax:517-351-8883
Practice Address - Street 1:1401 E LANSING DR
Practice Address - Street 2:SUITE 107
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7787
Practice Address - Country:US
Practice Address - Phone:517-351-8881
Practice Address - Fax:517-351-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP040011207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1103378991OtherBLUE CROSS
MI3200541OtherPHYSICIAN'S HEALTH PLAN
MI1623639Medicaid
MI1103378991OtherBLUE CROSS
MIB44089Medicare UPIN