Provider Demographics
NPI:1023133550
Name:RISHE, ERIC M (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:RISHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 KENSINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325
Mailing Address - Country:US
Mailing Address - Phone:917-570-6945
Mailing Address - Fax:
Practice Address - Street 1:12309 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:917-570-6945
Practice Address - Fax:954-432-6266
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111691207RH0003X
NY233492207RH0003X, 282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No282E00000XHospitalsLong Term Care Hospital