| Doctor Name: | MR. MARK A RISEN |
| NPI Number: | 1174571004 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 00216 |
| Business Practice Address: | 138 Campbellsville Byp Campbellsville, KY - 427188843 |
| Business Phone Number: | 2704335806 |
| Business Fax Number: | 2704332443 |
| Mailing Address: | 138 Campbellsville Byp, CAMPBELLSVILLE |
| State: | KY |
| Postal Code: | 427188843 |
| Phone Number: | 2704335806 |
| Fax Number: | 2704332443 |
| NPI Enumeration Date: | 05/04/2006 |
| NPI Last Update Date: | 04/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 00216 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |