Provider Demographics
NPI:1083605935
Name:RIESGRAF, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:RIESGRAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-229-4917
Mailing Address - Fax:320-229-5181
Practice Address - Street 1:1900 CENTRACARE CIRCLE
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-229-4917
Practice Address - Fax:320-229-5181
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1362965OtherARAZ GRP AMERICA'S PPO
51F43RIOtherBLUE CROSS BLUE SHIELD
2114105OtherFIRST HEALTH PLAN
112001OtherU CARE
HP11310OtherHEALTH PARTNERS
0107720OtherMEDICA HEALTH PLANS
1028600OtherPREFERRED ONE
298703100OtherMEDICAL ASSISTANCE
51F43RIOtherBLUE CROSS BLUE SHIELD
298703100OtherMEDICAL ASSISTANCE