Individual
DR. STACY MARIE RISSING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
STACY RISSING
Contact information
Practice address
550 UNIVERSITY BLVD, ROOM 0641, INDIANAPOLIS, IN 46202-5149
(317) 278-2449
Mailing address
6826 WOOD HAVEN PL, ZIONSVILLE, IN 46077-8560
(317) 402-6495
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01063834A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000668011
ANTHEM BCBS
IN
05
—
200989860
—
IN
01
—
P00896702
RAILROAD MEDICARE
IN
Enumeration date
06/28/2008
Last updated
02/29/2012
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