Healthcare Provider Details

I. General information

NPI: 1801356076
Provider Name (Legal Business Name): ALIXANDRA LEE RIDDERING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 E SHERMAN BLVD
MUSKEGON MI
49444-1847
US

IV. Provider business mailing address

1266 E SHERMAN BLVD
MUSKEGON MI
49444-1847
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-9009
  • Fax: 231-733-0566
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301511162
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number2023016704
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: