MEDICARE: DR. MICHAEL RISKEVICH D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	208815	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	208815	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1295897155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RISKEVICH D.O

Provider Business Mailing Address
First Line	:	2818 OCEAN AVE STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3170
Country	:	US
Telephone Number	:	718-934-8484
Fax Number	:	718-934-4267

Provider Business Practice Location Address
First Line	:	2818 OCEAN AVE STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3170
Country	:	US
Telephone Number	:	718-934-8484
Fax Number	:	718-934-4267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	03/13/2015

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