Healthcare Provider Details

I. General information

NPI: 1669613089
Provider Name (Legal Business Name): MARC RICKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2009
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 FAIRWAY ST
DICKINSON ND
58601-2590
US

IV. Provider business mailing address

1005 5TH AVE W
DICKINSON ND
58601-3836
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-6004
  • Fax:
Mailing address:
  • Phone: 216-816-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12730
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number098853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: