Provider Demographics
NPI:1679535264
Name:GARRELS, RICKY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:LEE
Last Name:GARRELS
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 1:4321 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1269
Mailing Address - Country:US
Mailing Address - Phone:563-421-5310
Mailing Address - Fax:888-367-9650
Practice Address - Street 1:4321 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1269
Practice Address - Country:US
Practice Address - Phone:563-421-5310
Practice Address - Fax:888-367-9650
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0896732083X0100X
IA293702083X0100X
IABG32663222083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK02942Medicare ID - Type Unspecified
IAI12028Medicare ID - Type Unspecified