Individual ProviderEzekiel RichardsonEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address4201 W Medical Center Dr, Mchenry, IL 60050-8409(815) 759-3100PECOS EnrollmentBased on the most recent information from CMS, provider Ezekiel Richardson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1598226433Provider TypeIndividualFull NameRichardson, EzekielCredentialMDGenderMaleSole ProprietorYesEnumeration Date3/25/2019Last Updated11/22/2023Contact InformationPractice LocationPractice Address4201 W Medical Center Dr, Mchenry, IL 60050-8409Phone(815) 759-3100Fax(815) 363-9094Mailing LocationMailing Address4201 W Medical Center Dr, Mchenry, IL 60050-8409Phone(815) 759-3100Fax(815) 363-9094Provider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense036160175IllinoisCode207P00000XDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense125.074575Illinois