Provider Demographics
NPI:1851641542
Name:IBADAT, RIZWAN HUSSAIN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:RIZWAN
Middle Name:HUSSAIN
Last Name:IBADAT
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:33110 WEST 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3307
Mailing Address - Country:US
Mailing Address - Phone:248-489-9070
Mailing Address - Fax:248-489-9076
Practice Address - Street 1:18254 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-4214
Practice Address - Country:US
Practice Address - Phone:313-861-4400
Practice Address - Fax:313-861-5810
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2015-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant