Provider Demographics
NPI:1023365129
Name:NAHEED RIZVI MD PLLC
Entity type:Organization
Organization Name:NAHEED RIZVI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-743-0396
Mailing Address - Street 1:2520 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6921
Mailing Address - Country:US
Mailing Address - Phone:989-513-4255
Mailing Address - Fax:
Practice Address - Street 1:2520 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6921
Practice Address - Country:US
Practice Address - Phone:989-513-4255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH93713Medicare UPIN