Provider Demographics
NPI:1376513127
Name:RISSMAN, LINDA SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:RISSMAN
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5974
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:31995 NORTHWESTERN HWY
Practice Address - Street 2:WEISBERG CANCER TREATMENT CENTER
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1625
Practice Address - Country:US
Practice Address - Phone:248-538-4701
Practice Address - Fax:248-538-6545
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010106442085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101010644OtherMEDICAL LICENSE ID NUMBER
MIF98439Medicare UPIN
MI0P30630504Medicare PIN
MI5101010644OtherMEDICAL LICENSE ID NUMBER