Provider Demographics
NPI:1629503172
Name:RIDER, ERICA JORDAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:JORDAN
Last Name:RIDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E. MEDICAL CENTER DRIVE F6790 UH SOUTH
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5243
Mailing Address - Country:US
Mailing Address - Phone:734-936-9704
Mailing Address - Fax:
Practice Address - Street 1:1500 E. MEDICAL CENTER DRIVE F6790 UH SOUTH
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5243
Practice Address - Country:US
Practice Address - Phone:734-936-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010254352080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine