Provider Demographics
NPI:1831142165
Name:RIZVI, NADEEM (MD)
Entity Type:Individual
Prefix:
First Name:NADEEM
Middle Name:
Last Name:RIZVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SYED
Other - Middle Name:
Other - Last Name:RIZVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0125
Mailing Address - Country:US
Mailing Address - Phone:888-731-1036
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6119
Practice Address - Country:US
Practice Address - Phone:314-923-4640
Practice Address - Fax:314-653-4131
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005032250207L00000X
PAMD469110207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203133OtherBCBS OF MISSOURI (GROUP #)
MO207547308Medicaid
37570OtherABA
0-515-681-5OtherECFMG
P00298359OtherRR MEDICARE
MO207547308Medicaid
37570OtherABA
ILK44781Medicare PIN
MO937514814Medicare PIN