Provider Demographics
NPI:1295727824
Name:TOOLEY, RICHARD NORMAN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:NORMAN
Last Name:TOOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 6TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2359
Mailing Address - Country:US
Mailing Address - Phone:231-935-2400
Mailing Address - Fax:231-935-2424
Practice Address - Street 1:1221 6TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2359
Practice Address - Country:US
Practice Address - Phone:231-935-2400
Practice Address - Fax:231-935-2424
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRT052793208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3169827Medicaid
MI3169827Medicaid
MIB86018137Medicare PIN