Provider Demographics
NPI:1790883635
Name:KIDDER, RONALD CURTIS (LP)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CURTIS
Last Name:KIDDER
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 FRANKLIN
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445
Mailing Address - Country:US
Mailing Address - Phone:231-744-8550
Mailing Address - Fax:
Practice Address - Street 1:376 E APPLE AVENUE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-724-1111
Practice Address - Fax:231-724-3348
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002467103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRK002467OtherBCBS PIN