Provider Demographics
NPI:1649502436
Name:RIALSON, JOHN A (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:RIALSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8805 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-7064
Mailing Address - Country:US
Mailing Address - Phone:231-779-3668
Mailing Address - Fax:231-779-4496
Practice Address - Street 1:8805 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-7064
Practice Address - Country:US
Practice Address - Phone:231-779-3668
Practice Address - Fax:231-779-4496
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPL60020323213ES0103X
MI5901002404213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery