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NPI Code Detail

MEDICARE: WILLIAM K RIORDAN DO

MEDICARE:   WILLIAM K RIORDAN  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician5101010779MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300088078OTHERMIRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
23052422495OTHERMIBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447259718
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM K RIORDAN DO
Provider Business Mailing Address
First Line : 416 CONNABLE AVE
Second Line :
City : PETOSKEY
State : MI
Zip : 49770-2297
Country : US
Telephone Number : 989-401-4245
Fax Number : 989-401-4235
Provider Business Practice Location Address
First Line : 416 CONNABLE AVE
Second Line :
City : PETOSKEY
State : MI
Zip : 49770-2212
Country : US
Telephone Number : 231-487-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 08/13/2018

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