Provider Demographics
NPI:1720311400
Name:RIETKERK, WILLIAM EDWARD (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:RIETKERK
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Gender:M
Credentials:MD MBA
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Mailing Address - Street 1:55 ROLLING OAKS DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-497-7529
Mailing Address - Fax:805-494-3486
Practice Address - Street 1:55 ROLLING OAKS DR STE 200
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1010
Practice Address - Country:US
Practice Address - Phone:212-661-3376
Practice Address - Fax:212-661-3366
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
CAA141249207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology