Individual
DR. STEPHEN RALPH RIBAUDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
229 RED COACH DR, SUITE 102, MISHAWAKA, IN 46545-3195
(574) 252-5852
(574) 252-5862
Mailing address
229 RED COACH DR, SUITE 102, MISHAWAKA, IN 46545-3195
(574) 252-5852
(574) 252-5862
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01034333
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090100A
—
IN
01
—
250000701
MEDICARE RAILROAD
IN
Enumeration date
09/01/2006
Last updated
12/23/2020
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