Provider Demographics
NPI:1689641664
Name:RIZK, ABDALLAH M (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDALLAH
Middle Name:M
Last Name:RIZK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:401 S. BALLENGER HIGHWAY
Mailing Address - Street 2:PHYSICIAN BILLING/CREDENTIALING
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1591
Practice Address - Street 1:6815 DIXIE HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2092
Practice Address - Country:US
Practice Address - Phone:248-625-1011
Practice Address - Fax:248-625-1011
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1018247OtherMCLAREN HEALHT PLAN
MI17470OtherMCARE
MI4854611Medicaid
MI01002723OtherGENESEE HEALTH PLAN
MI11OB510530OtherBCBSM
MI4817734Medicaid
MI4852690Medicaid
MI108247OtherHEALTH ADVANTAGE NETWORK
MIPOO284305 CJ6210OtherMETRA HEALTH
MI110B510530OtherBLUE CHOICE/BCN/COMM BLUE
MII48615OtherHAP
MI4817734Medicaid
MIPOO284305 CJ6210OtherMETRA HEALTH
MIOP40350092Medicare PIN