Provider Demographics
NPI:1184616682
Name:RISH, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:RISH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:32730 WALKER RD
Practice Address - Street 2:BUILDING H
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-4100
Practice Address - Country:US
Practice Address - Phone:440-930-4955
Practice Address - Fax:440-930-4960
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-11-17
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Provider Licenses
StateLicense IDTaxonomies
OH35070011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0252042Medicaid
OH990010364OtherRR MEDICARE
OH0252042Medicaid
OH990010364OtherRR MEDICARE
OHG27939Medicare UPIN