Healthcare Provider Details

I. General information

NPI: 1073257937
Provider Name (Legal Business Name): DEVIN J RICKS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

684 N PORT CRESCENT ST
BAD AXE MI
48413-1275
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4191
  • Fax:
Mailing address:
  • Phone: 989-912-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1073257937
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: