Provider Demographics
NPI:1295830453
Name:RISH, RONALD L (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:RISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-3066
Mailing Address - Country:US
Mailing Address - Phone:920-320-4380
Mailing Address - Fax:920-684-6636
Practice Address - Street 1:4303 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3066
Practice Address - Country:US
Practice Address - Phone:920-320-4380
Practice Address - Fax:920-684-6636
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42395207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34007100Medicaid
WI34007100Medicaid
WI000538055Medicare ID - Type Unspecified