Individual
MELVIN D RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1021 W 5TH AVE, GARY, IN 46402-1703
(219) 880-1190
(219) 880-0784
Mailing address
1021 W 5TH AVE, GARY, IN 46402-1703
(219) 880-1190
(219) 880-0784
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01055493A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000220255
ANTHEM, BCBS
IN
05
—
200373330
—
IN
Enumeration date
08/07/2006
Last updated
07/28/2016
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