Provider Demographics
NPI:1548376312
Name:RIZVI, SYED MA (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:MA
Last Name:RIZVI
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 1:801 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1270
Mailing Address - Country:US
Mailing Address - Phone:317-462-5544
Mailing Address - Fax:317-477-6361
Practice Address - Street 1:801 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1270
Practice Address - Country:US
Practice Address - Phone:317-462-5544
Practice Address - Fax:317-477-6361
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI51749207RG0100X
IN01088767A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00288288OtherRAILROAD MEDICARE
MI381358036011OtherTRICARE
WI1548376312Medicaid
MI4767605Medicaid
MI4767605Medicaid
I39764Medicare UPIN
WI736011542Medicare PIN