Provider Demographics
NPI:1235820705
Name:RINGSIDE MDS-MICHIGAN PLLC
Entity Type:Organization
Organization Name:RINGSIDE MDS-MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HECHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-205-0136
Mailing Address - Street 1:125 S STATE ROAD 7 STE 104
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4386
Mailing Address - Country:US
Mailing Address - Phone:561-247-2373
Mailing Address - Fax:567-823-3495
Practice Address - Street 1:6535 BATES RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9527
Practice Address - Country:US
Practice Address - Phone:561-247-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty