Provider Demographics
NPI:1285993253
Name:RIDDER, ANDREW JOHN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:RIDDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S CLIFF AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1023
Mailing Address - Country:US
Mailing Address - Phone:605-335-0844
Mailing Address - Fax:605-335-3951
Practice Address - Street 1:1301 S CLIFF AVE STE 506
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-335-0844
Practice Address - Fax:605-335-3951
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011023712084N0400X
390200000X
SD108942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program