Healthcare Provider Details

I. General information

NPI: 1841947371
Provider Name (Legal Business Name): RIZVI TIERNAN PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 DARLENE CT STE B
AURORA IL
60504-6523
US

IV. Provider business mailing address

1605 PEYTON TER
SHOREWOOD IL
60404-1220
US

V. Phone/Fax

Practice location:
  • Phone: 630-415-0056
  • Fax:
Mailing address:
  • Phone: 630-202-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ZAIN RIZVI
Title or Position: PRESIDENT
Credential: DPM
Phone: 630-202-0319