Healthcare Provider Details

I. General information

NPI: 1992235865
Provider Name (Legal Business Name): SYED MUAZ RIZVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 JOLIET RD STE 3
COUNTRYSIDE IL
60525-4662
US

IV. Provider business mailing address

2228 WEBER RD
CREST HILL IL
60403-0928
US

V. Phone/Fax

Practice location:
  • Phone: 708-246-4502
  • Fax:
Mailing address:
  • Phone: 815-729-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036.153968
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: