Provider Demographics
NPI:1508836172
Name:RIZVI, SYED MOHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:MOHSAN
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 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2235 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-3529
Practice Address - Country:US
Practice Address - Phone:574-647-4530
Practice Address - Fax:574-647-2285
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072465A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000831429OtherBCBS BMG SCHWARTZ-WIEKAMP
IN000000856151OtherBCBS BMG LAPORTE
IN000000884798OtherBCBS BMG ELKHART EAST
INP01371333OtherRR MEDICARE
IN169380076OtherMEDICARE PTAN
IN201162730Medicaid
IN000000857581OtherBCBS BMG GOSHEN
IN000000857581OtherBCBS BMG GOSHEN
IN000000831429OtherBCBS BMG SCHWARTZ-WIEKAMP