Provider Demographics
NPI:1811008725
Name:RISDON, ANTOINETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:RISDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 W GOLF RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-679-3079
Mailing Address - Fax:847-679-8340
Practice Address - Street 1:4711 W GOLF RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-679-3079
Practice Address - Fax:847-679-8340
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360726122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
31602774OtherBCBS
IL914800Medicare ID - Type Unspecified
31602774OtherBCBS