Provider Demographics
NPI: | 1831478882 |
---|---|
Name: | RIZKALLA, MICHAEL (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | |
Last Name: | RIZKALLA |
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: | 3100 SW 62 AVE |
Mailing Address - Street 2: | MIAMI CHILDREN'S HOSPITAL |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33155 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 786-624-3588 |
Mailing Address - Fax: | 305-662-8291 |
Practice Address - Street 1: | 3100 SW 62 AVE |
Practice Address - Street 2: | MIAMI CHILDREN'S HOSPITAL |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33155 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-624-3588 |
Practice Address - Fax: | 305-662-8291 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-08-09 |
Last Update Date: | 2015-04-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301101722 | 208000000X, 2080P0204X |
FL | ME122775 | 207PP0204X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207PP0204X | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
No | 2080P0204X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |