Provider Demographics
NPI:1881001428
Name:A R RICKFELDER PHD PC
Entity Type:Organization
Organization Name:A R RICKFELDER PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICKELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-348-1100
Mailing Address - Street 1:640 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1690
Mailing Address - Country:US
Mailing Address - Phone:248-348-1100
Mailing Address - Fax:248-348-3410
Practice Address - Street 1:640 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1690
Practice Address - Country:US
Practice Address - Phone:248-348-1100
Practice Address - Fax:248-348-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001110103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF34527OtherBCBS
MIOF34527OtherBCBS