Provider Demographics
NPI:1659394989
Name:QURESHI, RIZWAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:A
Last Name:QURESHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6800 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5414
Mailing Address - Country:US
Mailing Address - Phone:352-592-2003
Mailing Address - Fax:352-592-0433
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-592-2003
Practice Address - Fax:352-592-0433
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME736432080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL166975OtherSTAYWELL
FL263767OtherAVMED
FL42558OtherBC/BS
FL75060871OtherPRESTIGE
FL259144800Medicaid