Provider Demographics
NPI:1295908903
Name:M. NASIR RIZWI MD PA
Entity type:Organization
Organization Name:M. NASIR RIZWI MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:NASIR
Authorized Official - Last Name:RIZWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-589-6844
Mailing Address - Street 1:13060 US HIGHWAY 1
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3771
Mailing Address - Country:US
Mailing Address - Phone:772-388-2311
Mailing Address - Fax:772-388-0728
Practice Address - Street 1:13060 US HIGHWAY 1
Practice Address - Street 2:SUITE B
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3771
Practice Address - Country:US
Practice Address - Phone:772-388-2311
Practice Address - Fax:772-388-0728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M. NASIR RIZWI MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33935207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21357AMedicare PIN
FLD85605Medicare UPIN