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General NPI Number Information
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NPI Number | 1174571004
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Entity Type | Individual
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Provider Name | MARK A RISEN DPM
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1003 OLD GREENSBURG RD
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-2571
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Country | US
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Telephone | 270-433-5806
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Fax | 270-433-2443
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Provider Business Mailing Address
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Address Line | PO BOX 645996
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City | CINCINNATI
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State | OH
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Zip | 45264-5996
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Country | US
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Telephone | 270-651-4444
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Fax | 270-651-4892
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00216
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 00216
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License Number State | KY
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