Healthcare Provider Details

I. General information

NPI: 1275568578
Provider Name (Legal Business Name): RIZWAN K MOINUDDIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 309
MELROSE PARK IL
60160-1623
US

IV. Provider business mailing address

210 S DES PLAINES
CHICAGO IL
60661-5500
US

V. Phone/Fax

Practice location:
  • Phone: 312-654-2744
  • Fax: 312-651-4419
Mailing address:
  • Phone: 312-654-2721
  • Fax: 866-954-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036114326
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: