Richardson, Fred
Richardson, Fred is an individual health care provider with primary practice located at 904 Medical Park Dr Suite 3, Effingham IL 62401-2193. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Richardson, Fred can be contacted via phone (217) 540-2350.Contact Information
Primary practice address
904 Medical Park Dr Suite 3
Effingham IL 62401-2193
Phone: (217) 540-2350
Fax: (217) 347-2323
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036078174 | Illinois |
Profile Details
| NPI number | 1194702092 |
|---|---|
| LBN Legal business name | Richardson, Fred |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 30th, 2005 |
| Last updated | Apr 1st, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194702092 | NPPES |
| Illinois | MEDICAID | 036078174 |
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