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General NPI Number Information
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NPI Number | 1285993253
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Entity Type | Individual
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Provider Name | ANDREW JOHN RIDDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 1301 S CLIFF AVE STE 506
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City | SIOUX FALLS
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State | SD
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Zip | 57105
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Country | US
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Telephone | 605-335-0844
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Fax | 605-335-3951
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Provider Business Mailing Address
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Address Line | 1301 S CLIFF AVE STE 506
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1023
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Country | US
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Telephone | 605-335-0844
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Fax | 605-335-3951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301102371
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 10894
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License Number State | SD
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