Provider Demographics
NPI:1134120330
Name:RIZWI, MOHAMMAD NASIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:NASIR
Last Name:RIZWI
Suffix:
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 1:13885 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3232
Mailing Address - Country:US
Mailing Address - Phone:772-589-6844
Mailing Address - Fax:772-589-3227
Practice Address - Street 1:13885 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3232
Practice Address - Country:US
Practice Address - Phone:772-589-6844
Practice Address - Fax:772-589-3227
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33935207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054082000Medicaid
FLD85605Medicare UPIN
FL054082000Medicaid
FL31145ZMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE