Basic Information
| Provider Information | |||||||||
| NPI: | 1104843002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RITTER | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 SMITH AVE N | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512415290 | ||||||||
| FaxNumber: | 6512415248 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 SMITH AVE N | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512415290 | ||||||||
| FaxNumber: | 6512415248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 05/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 30492 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0402X | 28800 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 813773100 | 05 | MN | MEDICAID |