Healthcare Provider Details

I. General information

NPI: 1740307016
Provider Name (Legal Business Name): DEBRA L RICCIARDI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544A W DUNDEE RD
WHEELING IL
60090-2675
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200W
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 615-778-4066
  • Fax:
Mailing address:
  • Phone: 972-364-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number036-095110
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036095110
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: