Provider Demographics
NPI:1437103736
Name:RICKERL, SAMUEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAMES
Last Name:RICKERL
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 1:121 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-2041
Mailing Address - Country:US
Mailing Address - Phone:563-357-6980
Mailing Address - Fax:563-202-5307
Practice Address - Street 1:121 6TH AVE
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-2041
Practice Address - Country:US
Practice Address - Phone:563-357-6980
Practice Address - Fax:563-202-5307
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-31160207V00000X
IL036102988207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
023235OtherHEALTH ALLIANCE
19351OtherMIDLANDS CHOICE
IA0137570Medicaid
27198OtherIOWA HEALTH SOLUTIONS
IA55200OtherWELLMARK BC/BS
IA0165OtherJOHN DEERE HEALTH
19351OtherMIDLANDS CHOICE
19351OtherMIDLANDS CHOICE
023235OtherHEALTH ALLIANCE
IA0137570Medicaid