Provider Demographics
NPI:1477968584
Name:RIZVI, SYED ASHTER (MBBS, MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:ASHTER
Last Name:RIZVI
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:1910 ROCKLEDGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3751
Practice Address - Country:US
Practice Address - Phone:321-636-6599
Practice Address - Fax:321-636-6614
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI713902085R0202X
FLME1683892085R0202X
TXU48122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100090549Medicaid