Provider Demographics
NPI:1639752512
Name:RIZVI, SYED BASAR (DPM)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:BASAR
Last Name:RIZVI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 TRINITY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2652
Mailing Address - Country:US
Mailing Address - Phone:309-287-5412
Mailing Address - Fax:
Practice Address - Street 1:4305 BUTLER HILL RD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3718
Practice Address - Country:US
Practice Address - Phone:314-849-9009
Practice Address - Fax:314-849-9004
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024008263213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery