MEDICARE: RISIN PLASTIC SURGERY ASSOCIATES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician
2	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1346991957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISIN PLASTIC SURGERY ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 326
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-0326
Country	:	US
Telephone Number	:	732-515-5787
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 COCOANUT ROW STE B126
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4069
Country	:	US
Telephone Number	:	561-515-5787
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL SIMON RISIN
Credential	:	MD
Telephone Number	:	561-515-5787

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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