Provider Demographics
NPI:1801356076
Name:RIDDERING, ALIXANDRA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ALIXANDRA
Middle Name:LEE
Last Name:RIDDERING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1266 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1266 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1847
Practice Address - Country:US
Practice Address - Phone:231-739-9009
Practice Address - Fax:231-733-0566
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023016704207WX0120X
MI4301511162207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist