Provider Demographics
NPI:1740230838
Name:RITSCH, JODI HANSEN (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:HANSEN
Last Name:RITSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 BLAZING STAR BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720
Mailing Address - Country:US
Mailing Address - Phone:715-318-0050
Mailing Address - Fax:715-598-8813
Practice Address - Street 1:1476 BLAZING STAR BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720
Practice Address - Country:US
Practice Address - Phone:715-318-0050
Practice Address - Fax:715-598-8813
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI37454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32255900Medicaid
WI0247 20195Medicare ID - Type Unspecified
WI32255900Medicaid