Provider Demographics
NPI:1700107349
Name:RIZVI, FAWAD H (DO)
Entity Type:Individual
Prefix:DR
First Name:FAWAD
Middle Name:H
Last Name:RIZVI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3605
Mailing Address - Country:US
Mailing Address - Phone:347-526-8860
Mailing Address - Fax:
Practice Address - Street 1:6200 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3605
Practice Address - Country:US
Practice Address - Phone:734-526-8860
Practice Address - Fax:734-353-4108
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016547208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12149649OtherCAQH
MI5820929OtherBCBS TYPE 1 PIN # IND
MI5315047618OtherCDS #
MI1700107349OtherBCBS TYPE 1 (IND) NPI #
MIMI3786-001OtherMEDICARE IND PIN #
MI5101016547OtherSTATE LICENSE #