Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101023943 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036.156145 | IL |
NPI | 1285126656 |
---|---|
Provider Name | Dr. Abbas Ali Rizvi |
First Address | Grand Blanc, MI 48439-8065 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 21/04/2021 |