Provider Demographics
NPI:1619957420
Name:RIZVI, SHEHNAZ (MD)
Entity type:Individual
Prefix:DR
First Name:SHEHNAZ
Middle Name:
Last Name:RIZVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 MASON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2841
Mailing Address - Country:US
Mailing Address - Phone:313-278-2800
Mailing Address - Fax:248-932-2863
Practice Address - Street 1:1213 MASON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2841
Practice Address - Country:US
Practice Address - Phone:313-274-2525
Practice Address - Fax:313-274-5540
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1619957420Medicaid
MI700H222490OtherBLUE SHIELD/BCN
MI0N97850005Medicare PIN
MIG13590Medicare UPIN