Provider Demographics
NPI:1861495194
Name:RITZ, SHERWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERWIN
Middle Name:
Last Name:RITZ
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 1:215 E 1ST ST STE 153
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3175
Mailing Address - Country:US
Mailing Address - Phone:815-285-5603
Mailing Address - Fax:815-285-5813
Practice Address - Street 1:215 E 1ST ST STE 153
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3175
Practice Address - Country:US
Practice Address - Phone:815-285-5603
Practice Address - Fax:815-285-5813
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053594207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053594Medicaid
IL3634600005OtherCIGNA
ILL040569OtherCHAMPUS/TRICARE
IL040011299OtherMEDICARE RAILROAD
IL4475ROtherCATERPILLAR
IL364034475Medicaid
ILF400559128OtherMEDICARE PTAN
IL1083948OtherFIRST HEALTH