Individual
GARY S. RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1418 IROQUOIS PL, ANN ARBOR, MI 48104-4638
(734) 730-6753
Mailing address
PO BOX 4119, ANN ARBOR, MI 48106-4119
(734) 926-9264
(734) 527-6199
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
073466
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
073466
MI
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
073466
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411790510
—
MI
01
—
700H262220
BLUE CROSS-BLUE CROSS
—
01
—
GR073466
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
12/06/2006
Last updated
09/24/2015
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