Provider Demographics
NPI:1821369117
Name:RITTER, HEIDI ANTONETTE (DPM)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANTONETTE
Last Name:RITTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:A
Other - Last Name:HOLETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:540 MADISON OAK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3920
Mailing Address - Country:US
Mailing Address - Phone:210-479-3233
Mailing Address - Fax:512-485-0147
Practice Address - Street 1:540 MADISON OAK DR STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3920
Practice Address - Country:US
Practice Address - Phone:210-479-3233
Practice Address - Fax:512-485-0147
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2036213ES0103X
NY006452213ES0103X
TX2034213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB161116Medicare PIN