Provider Demographics
NPI:1780616540
Name:RITTER, MICHELE R (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:RITTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:UNION LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48387-0510
Mailing Address - Country:US
Mailing Address - Phone:248-932-2932
Mailing Address - Fax:248-932-2953
Practice Address - Street 1:1396 SCOTT LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1578
Practice Address - Country:US
Practice Address - Phone:248-932-2932
Practice Address - Fax:248-932-2953
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR070661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG57173Medicare UPIN