Provider Demographics
NPI:1275681611
Name:RICKE, TRACY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:RICKE
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 1:3360 S COON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3220
Mailing Address - Country:US
Mailing Address - Phone:612-298-6144
Mailing Address - Fax:
Practice Address - Street 1:3360 S COON CREEK DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3220
Practice Address - Country:US
Practice Address - Phone:612-298-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN536382080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine