Provider Demographics
NPI:1952099954
Name:RIZVI, SYED FAZAL MEHDI (MBBS)
Entity Type:Individual
Prefix:
First Name:SYED FAZAL
Middle Name:MEHDI
Last Name:RIZVI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 B D WING SIMLA HOUSE, MALABAR HILL
Mailing Address - Street 2:
Mailing Address - City:MUMBAI
Mailing Address - State:MAHARASHTRA
Mailing Address - Zip Code:400006
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3333 GREEN BAY ROAD, 1.363A-BSB
Practice Address - Street 2:MEDICINE RESIDENCY ADMINISTRATOR-CHICAGO MEDICAL SCHOOL
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-578-3227
Practice Address - Fax:847-578-8778
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2024-01-26
Deactivation Date:2023-11-30
Deactivation Code:
Reactivation Date:2024-01-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program