Provider Demographics
NPI:1043520299
Name:MOHAMMAD RIAZ MD
Entity Type:Organization
Organization Name:MOHAMMAD RIAZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-763-4011
Mailing Address - Street 1:204 NE 19TH DR
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1932
Mailing Address - Country:US
Mailing Address - Phone:863-763-4011
Mailing Address - Fax:863-467-1156
Practice Address - Street 1:204 NE 19TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1932
Practice Address - Country:US
Practice Address - Phone:863-763-4011
Practice Address - Fax:863-467-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43238174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068559300Medicaid
FL060054371OtherMEDICARE RAILROAD
FL060054371OtherMEDICARE RAILROAD
FL068559300Medicaid