Provider Demographics
NPI:1790739365
Name:MUFTI, RIZWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:
Last Name:MUFTI
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 1:35379 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010644402084F0202X
OH351331812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790739365Medicaid
MIMI8362001Medicare PIN
MA1039210OtherNHP
MA2068290Medicaid
MA2068290OtherMBHP
MAI04909Medicare UPIN
MA020056OtherBMC HEALTHNET