Healthcare Provider Details

I. General information

NPI: 1497990972
Provider Name (Legal Business Name): MICHAEL V RIESBERG MD OTOLARYNGOLOGY & PERFORMING ARTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N. DAVIS HIGHWAY
PENSACOLA FL
32503-2344
US

IV. Provider business mailing address

PO BOX 1759 DEPARTMENT 952
HOUSTON TX
77251-1759
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-0700
  • Fax: 850-476-4300
Mailing address:
  • Phone: 713-554-5304
  • Fax: 713-554-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MICHAEL V RIESBER
Title or Position: PRESIDENT
Credential: MD
Phone: 850-476-0700