Provider Demographics
NPI:1497763700
Name:RIZVI, SHAMBEEL H (MD)
Entity Type:Individual
Prefix:
First Name:SHAMBEEL
Middle Name:H
Last Name:RIZVI
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 1:9749 GREENSPRUCE CT N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1515
Mailing Address - Country:US
Mailing Address - Phone:612-226-6576
Mailing Address - Fax:763-390-4035
Practice Address - Street 1:536 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8403
Practice Address - Country:US
Practice Address - Phone:763-634-2273
Practice Address - Fax:763-390-4035
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49134207RR0500X
MN52523207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34842300Medicaid
WI007639315Medicare ID - Type Unspecified
WII51484Medicare UPIN
WI34842300Medicaid