Individual
MONIQUE A RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
32730 WALKER RD, BUILDING H, AVON LAKE, OH 44012-4100
(440) 930-4955
(440) 930-4960
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35072339
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080118001
RR MEDICARE
OH
05
—
2051489
—
OH
Enumeration date
08/19/2005
Last updated
11/10/2020
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