Provider Demographics
NPI:1467507343
Name:RIZVI, TARA (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:RIZVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14053 MEMORIAL DR UNIT 332
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6826
Mailing Address - Country:US
Mailing Address - Phone:617-947-5619
Mailing Address - Fax:346-202-0088
Practice Address - Street 1:23920 KATY FWY STE 440
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0881
Practice Address - Country:US
Practice Address - Phone:346-257-4300
Practice Address - Fax:346-202-0088
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3073207RR0500X, 207RR0500X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L5261Medicare PIN
TX8L24338Medicare PIN