Provider Demographics
NPI:1750327631
Name:RITTER, THOMAS L (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:RITTER
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 1:60 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2296
Mailing Address - Country:US
Mailing Address - Phone:269-687-0808
Mailing Address - Fax:269-687-0811
Practice Address - Street 1:60 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2296
Practice Address - Country:US
Practice Address - Phone:269-687-0808
Practice Address - Fax:269-687-0811
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046594207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160023110OtherRAILROAD MEDICARE
MI1601107002OtherBLUE CROSS PIN
MI4087083Medicaid
MIAR2314273OtherDEA
MI160023110OtherRAILROAD MEDICARE
B46444Medicare UPIN
MI4087083Medicaid