Provider Demographics
NPI:1275568578
Name:MOINUDDIN, RIZWAN K (DO)
Entity Type:Individual
Prefix:
First Name:RIZWAN
Middle Name:K
Last Name:MOINUDDIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 S DES PLAINES
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2721
Mailing Address - Fax:866-954-5804
Practice Address - Street 1:20121 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1009
Practice Address - Country:US
Practice Address - Phone:708-625-4132
Practice Address - Fax:708-748-8090
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036114326207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology