DR. DUSTIN DAVID RIDDLE DCDPMMHA NPI 1972617629

NPI Information

NPI: 1972617629
Provider Name: DR. DUSTIN DAVID RIDDLE, DC,DPM,MHA
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

Organization: GREAT FALLS CLINIC LLP

PECOS Registration: Yes

Address:
W2654 COUNTY ROAD KK
APPLETON, WI
ZIP 54915
Phone: (920) 830-2221
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DR. Dustin David Riddle, DC,DPM,MHA is a foot and ankle surgery podiatrist in Appleton, WI with 9 years of experience. DR. Dustin David Riddle, DC,DPM,MHA NPI is 1972617629. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

W2654 COUNTY ROAD KK
APPLETON, WI
ZIP 54915-468
Phone: (920) 830-2221

The NPI 1972617629 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 8/19/2006 and was last updated on 4/26/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor		3880-012	WISCONSIN	No
2	213ES0103X	Podiatrist	Foot & Ankle Surgery	1127-25	WISCONSIN	Yes
3	213ES0103X	Podiatrist	Foot & Ankle Surgery	135000875	ILLINOIS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	38961800	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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