Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME148370 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 182832 | NC |
NPI | 1023376928 |
---|---|
Provider Name | Dr. Michael Raisch |
First Address | Atlanta, GA 30384-8054 |
Second Address | Miami, FL 33176-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 09/02/2022 |