MEDICARE: JAY E RISSOVER MD

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	207R00000X	Internal Medicine Physician	35053312R	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639140890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY E RISSOVER MD

Provider Business Mailing Address
First Line	:	PO BOX 635156
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5156
Country	:	US
Telephone Number	:	513-745-9993
Fax Number	:	513-745-9269

Provider Business Practice Location Address
First Line	:	4620 GLENDALE MILFORD RD
Second Line	:	SUITE 101
City	:	CINCINNATI
State	:	OH
Zip	:	45242-3704
Country	:	US
Telephone Number	:	513-745-9993
Fax Number	:	513-745-9269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	03/02/2012

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Directions to “ JAY E RISSOVER MD” Practice Location

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