Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 41410 | MN |
Y | 208600000X | Surgeon | 41410 | MN |
N | 2086S0102X | Surgical Critical Care | 41410 | MN |
NPI | 1225064306 |
---|---|
Provider Name | Chad Richardson |
First Address | Minneapolis, MN 55415-1623 |
Second Address | Minneapolis, MN 55404-1210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H62868 | (02) |