Provider Demographics
NPI:1609261098
Name:RIZZO, DEREK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:RIZZO
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 1:33 W ONTARIO ST APT 26I
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7766
Mailing Address - Country:US
Mailing Address - Phone:586-864-5189
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HOSPITAL
Practice Address - Street 2:2799 W GRAND BLVD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:800-653-6568
Practice Address - Fax:313-916-9867
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.066871207L00000X
390200000X
MI4301502167207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty