Provider Demographics
NPI:1346443520
Name:STEPHEN RALPH RIBAUDO PC
Entity Type:Organization
Organization Name:STEPHEN RALPH RIBAUDO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:RIBAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-252-5852
Mailing Address - Street 1:229 RED COACH DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3195
Mailing Address - Country:US
Mailing Address - Phone:574-525-5852
Mailing Address - Fax:574-252-5862
Practice Address - Street 1:229 RED COACH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3195
Practice Address - Country:US
Practice Address - Phone:574-525-5852
Practice Address - Fax:574-252-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034333208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDG1929OtherMEDICARE RAILROAD
IN200886440AMedicaid
INA78330Medicare UPIN
IN162740Medicare PIN