Provider Demographics
NPI:1558341370
Name:RISSELL, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:RISSELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:STE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-385-8725
Mailing Address - Fax:414-385-8730
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:STE 170
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-385-1277
Practice Address - Fax:414-385-8730
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-11-14
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Provider Licenses
StateLicense IDTaxonomies
WI34271207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31912700Medicaid
1588963508Medicare NSC
WI0264580001Medicare NSC
WI0264580002Medicare NSC
1427347822Medicare NSC