| Doctor Name: | DR. TIMOTHY MARK RITTENOUR |
| NPI Number: | 1104881572 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 33334 |
| Business Practice Address: | 412 North Main Warroad, MN - 567632342 |
| Business Phone Number: | 2183862020 |
| Business Fax Number: | 2183863341 |
| Mailing Address: | 700 W Ironwood Dr, Suite 120e COEUR D ALENE |
| State: | ID |
| Postal Code: | 838142656 |
| Phone Number: | 2086679110 |
| Fax Number: | 2086761272 |
| NPI Enumeration Date: | 04/19/2006 |
| NPI Last Update Date: | 10/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 33334 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |