Individual
DR. RICHARD DOUGLAS SOUTHGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 N WESTMORELAND RD # LEVEL3, LAKE FOREST, IL 60045-1658
(847) 535-8500
(847) 535-8499
Mailing address
1000 N WESTMORELAND RD # LEVEL3, LAKE FOREST, IL 60045-1658
(847) 535-8500
(847) 535-8499
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
142231
CA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
036162961
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD184629
OR MEDICAL LICENSE
OR
Enumeration date
04/07/2010
Last updated
02/02/2023
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