Provider Demographics
NPI:1407376346
Name:RIPPLE, MICHAEL JOSEPH (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:RIPPLE
Suffix:
Gender:M
Credentials:MD PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PL # 3S34
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6006
Mailing Address - Fax:314-454-4102
Practice Address - Street 1:1 CHILDRENS PL # 3S34
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6006
Practice Address - Fax:314-454-4102
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017019513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics