Provider Demographics
NPI:1750450250
Name:RIZK, TEWFIK ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:TEWFIK
Middle Name:ELIAS
Last Name:RIZK
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 1:4508 BARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-761-2327
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVENUE
Practice Address - Street 2:SUITE 921
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3495
Practice Address - Country:US
Practice Address - Phone:901-527-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD013547208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3187654Medicaid
B04289Medicare UPIN
TN3187654Medicare ID - Type Unspecified