Provider Demographics
NPI:1851591044
Name:RIVAS, ERICK F (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:F
Last Name:RIVAS
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 1:4 E OGDEN AVE UNIT 348
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3506
Mailing Address - Country:US
Mailing Address - Phone:517-273-1540
Mailing Address - Fax:517-827-4909
Practice Address - Street 1:288 PEACE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9562
Practice Address - Country:US
Practice Address - Phone:517-273-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090493207Q00000X, 208600000X
IL036141982208600000X, 207Q00000X
IN01072759A2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN260690016Medicare PIN
IN201188570Medicaid