Provider Demographics
NPI:1568525988
Name:RIDER, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:RIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-433-3640
Mailing Address - Fax:920-433-3716
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:2 FLOOR
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3640
Practice Address - Fax:920-433-3716
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN44251207R00000X
WI50202-20207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105189687Medicaid
WI34191300Medicaid
MI0B10043OtherBCBS - MI PIN #
MI0B10043OtherBCBS - MI PIN #
H48973Medicare UPIN
WI34191300Medicaid
MIOP38340029Medicare Oscar/Certification
WI002150192Medicare Oscar/Certification
WI004920102Medicare Oscar/Certification