Provider Demographics
NPI:1649472556
Name:BLOCK-RISSMAN, ALISSA E (DO)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:E
Last Name:BLOCK-RISSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:E
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:830 W END CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1365
Practice Address - Country:US
Practice Address - Phone:847-522-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics