Provider Demographics
NPI:1710994181
Name:RICCI, JAMES D
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:RICCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:DALE
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:524 WHISPERING OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010
Mailing Address - Country:US
Mailing Address - Phone:618-377-1357
Mailing Address - Fax:618-474-2937
Practice Address - Street 1:524 WHISPERING OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010
Practice Address - Country:US
Practice Address - Phone:618-371-1357
Practice Address - Fax:618-474-2937
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10501Medicare UPIN