Basic Information
Provider Information
NPI: 1003013392
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RATCHFORD
FirstName: ERIK
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 245 CHERRY ST SE,
Address2: SUITE 202
City: GRAND RAPIDS
State: MI
PostalCode: 495034607
CountryCode: US
TelephoneNumber: 6164593551
FaxNumber: 6164591060
Practice Location
Address1: 245 CHERRY ST SE,
Address2: SUITE 202
City: GRAND RAPIDS
State: MI
PostalCode: 495034607
CountryCode: US
TelephoneNumber: 6164593551
FaxNumber: 6164591060
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 07/18/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X5101017248MIY Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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