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Organization
JAY RISEMAN MD LTD
Active
Organization
JAY RISEMAN MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY A RISEMAN MD (OFFICER)
(217) 629-8711
Entity
Organization
Contact information
Practice address
2524 FARRAGUT DR, SUITE C, SPRINGFIELD, IL 62704-8400
(217) 546-8711
(217) 546-8720
Mailing address
2524 FARRAGUT DR, SUITE C, SPRINGFIELD, IL 62704-8400
(217) 546-8711
(217) 546-8720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
208600000X
Surgery Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08400721
BLUECROSS BLUESHIELD
IL
01
—
087768
HEALTH ALLIANCE
IL
01
—
148336
HEALTHLINK NETWORK ID
IL
01
—
3001
NEIC SITE ID,NSF BAO-7
—
Enumeration date
03/22/2007
Last updated
10/31/2007
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