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General NPI Number Information
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NPI Number | 1326007774
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Entity Type | Individual
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Provider Name | MICHAEL RYSKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 1010 W 2ND ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2217
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Country | US
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Telephone | 812-334-3955
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Fax | 812-334-5792
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | BLOOMINGTON
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State | IN
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Zip | 47402-1329
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Country | US
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Telephone | 812-353-9816
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Fax | 812-334-5792
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 34.0138679
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 43490
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01070038A
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License Number State | IN
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