Basic Information
Provider Information
NPI: 1023272507
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RISSING
FirstName: DAVID
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 450 E 96TH ST STE 200
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462403797
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 8111 S EMERSON AVE
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462378601
CountryCode: US
TelephoneNumber: 3175285856
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/15/2008
LastUpdateDate: 03/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X01063782AINY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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