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Individual

DR. MICAH ROSE RICHARDSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Mailing address
PO BOX 735263, CHICAGO, IL 60673-5263
(877) 632-6637
(708) 409-5179

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01095627A
IN
207X00000X
Orthopaedic Surgery Physician
Primary
036173831
IL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
01095627A
IN
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
036173831
IL
208600000X
Surgery Physician
MD478807
PA
390200000X
Student in an Organized Health Care Education/Training Program
MT217723
PA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
03/29/2019
Last updated
07/08/2025
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