Provider Demographics
NPI:1376515841
Name:RIZOS, STEPHANOS (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANOS
Middle Name:
Last Name:RIZOS
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8355
Practice Address - Street 1:3500 FRANCISCAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-0021
Practice Address - Country:US
Practice Address - Phone:219-861-8785
Practice Address - Fax:219-861-8789
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000721927OtherANTHEM TRADITIONAL
IN200119130Medicaid
IN200119130Medicaid
IN000000721927OtherANTHEM TRADITIONAL
INM400052841Medicare PIN