Basic Information
| Provider Information | |||||||||
| NPI: | 1447884648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RISTE | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1924 DORCHESTER DR | ||||||||
| Address2: | |||||||||
| City: | COMMERCE TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483902990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488753086 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 N STAEBLER RD | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481039755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342526522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2020 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 820799715 | MI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP |
No ID Information.