Provider Demographics
NPI:1548328321
Name:RICHARDS, STACY KATHLEEN (MD)
Entity type:Individual
Prefix:MISS
First Name:STACY
Middle Name:KATHLEEN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6700 N ROCHESTER RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4362
Mailing Address - Country:US
Mailing Address - Phone:248-650-1520
Mailing Address - Fax:
Practice Address - Street 1:6700 N ROCHESTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4362
Practice Address - Country:US
Practice Address - Phone:248-650-1520
Practice Address - Fax:248-650-1530
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08063294161 002OtherBCBS
MI2976080 TYPE 10Medicaid
MIF22171Medicare UPIN