Individual
DR. AUDREY C RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1800 N MAIN ST, WHEATON, IL 60187-3112
(630) 614-4960
(630) 682-3727
Mailing address
1800 N MAIN ST, WHEATON, IL 60187-3112
(630) 614-4960
(630) 682-3727
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
125043627
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036114931
MEDICAID
IL
05
—
125043627
—
IL
05
—
4301086494
—
MI
01
—
920540
MEDICARE (GROUP PTAN)
IL
01
—
CE8792
MEDICARE RAILROAD (GROUP)
IL
01
—
F400100134
MEDICARE (INDIVIDUAL PTAN)
IL
01
—
P01245139
MEDICARE RAILROAD (INDIVIDUAL)
IL
Enumeration date
08/26/2005
Last updated
04/09/2014
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