Provider Demographics
NPI:1134430853
Name:RIDDEL, NICHOLE M (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:M
Last Name:RIDDEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:NICHOLE
Other - Middle Name:M
Other - Last Name:BAALMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9769
Practice Address - Street 1:8444 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1752
Practice Address - Country:US
Practice Address - Phone:316-274-9850
Practice Address - Fax:316-721-9574
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine