MEDICARE: DR. SHERWIN RITZ M.D.

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
1	207Y00000X	Otolaryngology Physician	036-053594	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	040011299	OTHER	IL	MEDICARE RAILROAD
7	F400559128	OTHER	IL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3634600005	OTHER	IL	CIGNA
3	L040569	OTHER	IL	CHAMPUS/TRICARE
5	4475R	OTHER	IL	CATERPILLAR
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1083948	OTHER	IL	FIRST HEALTH

General Provider Information

NPI Number	:	1861495194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERWIN RITZ M.D.

Provider Business Mailing Address
First Line	:	215 E 1ST ST STE 153
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3175
Country	:	US
Telephone Number	:	815-285-5603
Fax Number	:	815-285-5813

Provider Business Practice Location Address
First Line	:	215 E 1ST ST STE 153
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3175
Country	:	US
Telephone Number	:	815-285-5603
Fax Number	:	815-285-5813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/08/2019

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Directions to “ DR. SHERWIN RITZ M.D.” Practice Location

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