MEDICARE: DR. KEITH L RITCHIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	149956-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194717033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH L RITCHIE MD

Provider Business Mailing Address
First Line	:	1508 RIVER OAKS DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6328
Country	:	US
Telephone Number	:	801-943-7834
Fax Number	:	801-944-3038

Provider Business Practice Location Address
First Line	:	1508 RIVER OAKS DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6328
Country	:	US
Telephone Number	:	801-943-7834
Fax Number	:	801-944-3038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/22/2008

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