Provider Demographics
NPI:1245237155
Name:RIZK, TALLAT M (MD)
Entity Type:Individual
Prefix:DR
First Name:TALLAT
Middle Name:M
Last Name:RIZK
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 1:3152 LITTLE RD STE 162
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1864
Mailing Address - Country:US
Mailing Address - Phone:847-289-5727
Mailing Address - Fax:
Practice Address - Street 1:3152 LITTLE RD STE 162
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1864
Practice Address - Country:US
Practice Address - Phone:847-289-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150284208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
107175Medicare UPIN