Provider Demographics
NPI:1487746632
Name:RIVES, AARON BARRY (DPM)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:BARRY
Last Name:RIVES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 KING RD
Mailing Address - Street 2:STE 2
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7957
Mailing Address - Country:US
Mailing Address - Phone:734-479-1410
Mailing Address - Fax:734-479-4484
Practice Address - Street 1:14500 KING RD
Practice Address - Street 2:STE 2
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7957
Practice Address - Country:US
Practice Address - Phone:734-479-1410
Practice Address - Fax:734-479-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAR001004213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5825035OtherBLUE CROSS/BLUE SHIELD
MI1794500Medicaid
MI1794500Medicaid
MI5825035OtherBLUE CROSS/BLUE SHIELD