Provider Demographics
NPI:1578155594
Name:RIEDER, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:RIEDER
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 1:14773 THIRTEEN MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:DENFIELD
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N0M1P0
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL
Practice Address - Street 2:800 COMMISSIONER'S ROAD EAST
Practice Address - City:LONDON
Practice Address - State:ONTARIO
Practice Address - Zip Code:N0M 1P0
Practice Address - Country:CA
Practice Address - Phone:519-685-8293
Practice Address - Fax:519-685-8156
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301402142208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics