MEDICARE: THEODORE F RITZER 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	21394	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3060334	OTHER	TN	MEDICARE ID - TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4185003	OTHER	TN	BLUE CROSS BLUE SHIELD OF TN

General Provider Information

NPI Number	:	1942291372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE F RITZER MD

Provider Business Mailing Address
First Line	:	647 DUNLOP LN
Second Line	:	SUITE 203
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-5165
Country	:	US
Telephone Number	:	931-502-3750
Fax Number	:	931-502-3755

Provider Business Practice Location Address
First Line	:	647 DUNLOP LN
Second Line	:	STE 101
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-5165
Country	:	US
Telephone Number	:	931-502-3750
Fax Number	:	931-502-3755

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/15/2013

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Directions to “ THEODORE F RITZER MD” Practice Location

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