Healthcare Provider Details

I. General information

NPI: 1184616682
Provider Name (Legal Business Name): MICHAEL J RISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32730 WALKER RD BUILDING H
AVON LAKE OH
44012-4100
US

IV. Provider business mailing address

26908 DETROIT RD SUITE 301
WESTLAKE OH
44145-2398
US

V. Phone/Fax

Practice location:
  • Phone: 440-930-4955
  • Fax: 440-930-4960
Mailing address:
  • Phone: 440-617-1823
  • Fax: 440-617-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35070011
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: