Provider Demographics
NPI:1730152133
Name:RICHTER MD PC
Entity type:Organization
Organization Name:RICHTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAEK
Authorized Official - Middle Name:H
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-819-2414
Mailing Address - Street 1:8355 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-4618
Mailing Address - Country:US
Mailing Address - Phone:248-666-6005
Mailing Address - Fax:248-666-6669
Practice Address - Street 1:8355 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4618
Practice Address - Country:US
Practice Address - Phone:248-666-6005
Practice Address - Fax:248-666-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR053494208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080186543OtherMEDICARE TRAVELERS
MI080F322550OtherBCBS
0994309OtherHEALTH PLUS
MI440849310Medicaid
080F322550OtherBLUECARE NETWORK
P3210OtherBLUECARE NETWORK
F60165OtherHAP
F60165OtherHAP
F10165Medicare UPIN
080186543OtherMEDICARE TRAVELERS