Provider Demographics
NPI:1568702116
Name:RIZWAN M MUFTI, MD., PC.
Entity Type:Organization
Organization Name:RIZWAN M MUFTI, MD., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIZWAN
Authorized Official - Middle Name:MEHMOOD
Authorized Official - Last Name:MUFTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-986-7500
Mailing Address - Street 1:35379 NORTHMONT DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2648
Mailing Address - Country:US
Mailing Address - Phone:248-986-7500
Mailing Address - Fax:
Practice Address - Street 1:26631 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4530
Practice Address - Country:US
Practice Address - Phone:248-552-8195
Practice Address - Fax:248-552-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568702116Medicaid
MIMI8362Medicare PIN