Provider Demographics
NPI:1104804053
Name:RISK, WINTHROP S II (MD)
Entity type:Individual
Prefix:MR
First Name:WINTHROP
Middle Name:S
Last Name:RISK
Suffix:II
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 1:811 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2421
Mailing Address - Country:US
Mailing Address - Phone:319-362-7924
Mailing Address - Fax:319-362-1435
Practice Address - Street 1:811 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2421
Practice Address - Country:US
Practice Address - Phone:319-362-7924
Practice Address - Fax:319-362-1435
Is Sole Proprietor?:No
Enumeration Date:2006-01-01
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA358832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38919OtherWELLMARK
IAIA0111OtherHERITAGE
IA0450387Medicaid
IAI21927Medicare UPIN
IAI14160Medicare ID - Type Unspecified