Provider Demographics
NPI:1699793984
Name:RISING, LYDIA ORLENE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ORLENE
Last Name:RISING
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1251 LAKE CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2813
Mailing Address - Country:US
Mailing Address - Phone:248-855-8077
Mailing Address - Fax:248-855-4653
Practice Address - Street 1:43902 WOODWARD AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5011
Practice Address - Country:US
Practice Address - Phone:248-454-7650
Practice Address - Fax:248-454-9794
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-02-04
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Provider Licenses
StateLicense IDTaxonomies
MI5601003506363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ70385Medicare UPIN