Individual
DR. JEFFREY M RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9756
(616) 364-4200
(616) 364-7347
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9756
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5101008399
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050054284
RAILROAD MEDICARE
MI
01
—
050D110480
BCBS GROUP BILL PIN
MI
05
—
3318293
—
MI
01
—
5410038
BCBS PIN
MI
01
—
CE1952
RAILROAD GROUP NUMBER
MI
01
—
JR008399
BCBS LICENSE NUMBER
MI
Enumeration date
04/10/2006
Last updated
07/03/2014
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