Provider Demographics
NPI:1831478882
Name:RIZKALLA, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SW 62 AVE
Mailing Address - Street 2:MIAMI CHILDREN'S HOSPITAL
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:786-624-3588
Mailing Address - Fax:305-662-8291
Practice Address - Street 1:3100 SW 62 AVE
Practice Address - Street 2:MIAMI CHILDREN'S HOSPITAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:786-624-3588
Practice Address - Fax:305-662-8291
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2015-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301101722208000000X, 2080P0204X
FLME122775207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine