Provider Demographics
NPI:1043247042
Name:RITHOLZ, JUDITH ELEN (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELEN
Last Name:RITHOLZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 N HAMPDEN CT APT 1906
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4837
Mailing Address - Country:US
Mailing Address - Phone:312-618-4369
Mailing Address - Fax:
Practice Address - Street 1:2754 N HAMPDEN CT APT 1906
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4837
Practice Address - Country:US
Practice Address - Phone:312-618-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084838207RC0200X
IN01074611A207RC0200X, 207RP1001X
OH35134274207RC0200X
IL036087847207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4685036Medicaid
IN201352220Medicaid
MI11011-1057-1OtherBLUE CROSS PIN
MI1538397120OtherNPI- GROUP
MIP00874060OtherRR MEDICARE
MI270381199OtherTAX ID
IN000001009771OtherANTHEM PROVIDER NUMBER
IN000001009771OtherANTHEM PROVIDER NUMBER
MIMI2051067Medicare PIN
IN000001009771OtherANTHEM PROVIDER NUMBER
MI11011-1057-1OtherBLUE CROSS PIN