Healthcare Provider Details

I. General information

NPI: 1134120330
Provider Name (Legal Business Name): MOHAMMAD NASIR RIZWI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13885 US HIGHWAY 1
SEBASTIAN FL
32958-3232
US

IV. Provider business mailing address

13885 US HIGHWAY 1
SEBASTIAN FL
32958-3232
US

V. Phone/Fax

Practice location:
  • Phone: 772-589-6844
  • Fax: 772-589-3227
Mailing address:
  • Phone: 772-589-6844
  • Fax: 772-589-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME33935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: