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General NPI Number Information
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NPI Number | 1801356076
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Entity Type | Individual
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Provider Name | ALIXANDRA LEE RIDDERING MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 1266 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1847
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Country | US
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Telephone | 231-739-9009
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Fax | 231-733-0566
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Provider Business Mailing Address
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Address Line | 1266 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1847
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Country | US
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Telephone |
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Fax |
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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 | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number | 2023016704
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301511162
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License Number State | MI
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