Provider Demographics
NPI:1518901560
Name:RISPLER, DAVID T (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:RISPLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3565 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5335
Mailing Address - Country:US
Mailing Address - Phone:616-459-9404
Mailing Address - Fax:616-233-1108
Practice Address - Street 1:350 LAFAYETTE AVE SE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4656
Practice Address - Country:US
Practice Address - Phone:616-459-9404
Practice Address - Fax:616-233-1108
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084611207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4690733Medicaid
MI4690733Medicaid
MIF62732Medicare UPIN