Healthcare Provider Details

I. General information

NPI: 1831478882
Provider Name (Legal Business Name): MICHAEL RIZKALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 10/12/2026
Certification Date: 10/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62 AVE MIAMI CHILDREN'S HOSPITAL
MIAMI FL
33155
US

IV. Provider business mailing address

3100 SW 62 AVE MIAMI CHILDREN'S HOSPITAL
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-3588
  • Fax: 305-662-8291
Mailing address:
  • Phone: 786-624-3588
  • Fax: 305-662-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number4301101722
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101722
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME122775
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberME122775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: