Provider Demographics
NPI:1356612501
Name:RINGO, DEMETRICE NESHAWN
Entity type:Individual
Prefix:MR
First Name:DEMETRICE
Middle Name:NESHAWN
Last Name:RINGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3115
Mailing Address - Country:US
Mailing Address - Phone:414-464-7098
Mailing Address - Fax:
Practice Address - Street 1:5302 N 63RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3115
Practice Address - Country:US
Practice Address - Phone:414-464-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor