Provider Demographics
NPI:1083822753
Name:RITS, YEVGENIY (MD)
Entity Type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:
Last Name:RITS
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 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2065
Mailing Address - Country:US
Mailing Address - Phone:313-262-1258
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R #615
Practice Address - Street 2:HARPER PROFESSIONAL BLDG
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2065
Practice Address - Country:US
Practice Address - Phone:313-745-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010779082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN258415000Medicaid
MN770000079Medicare PIN