Provider Demographics
NPI:1376546283
Name:RISCHALL, MARTIN J (DPM)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:RISCHALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 S CLOVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6438
Mailing Address - Country:US
Mailing Address - Phone:636-928-1240
Mailing Address - Fax:636-928-1242
Practice Address - Street 1:4201 S CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6438
Practice Address - Country:US
Practice Address - Phone:636-928-1240
Practice Address - Fax:636-928-1242
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000509213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO303793616Medicaid
MO000021513Medicare PIN
MO303793616Medicaid
MO007012838Medicare PIN