Healthcare Provider Details

I. General information

NPI: 1639979743
Provider Name (Legal Business Name): MICHAEL DIRK RISCH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PRAIRIE CENTER PKWY
BRIGHTON CO
80601-4006
US

IV. Provider business mailing address

11405 KITTREDGE ST
COMMERCE CITY CO
80022-8616
US

V. Phone/Fax

Practice location:
  • Phone: 303-931-9304
  • Fax:
Mailing address:
  • Phone: 408-674-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.1690229
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: