Healthcare Provider Details

I. General information

NPI: 1881894707
Provider Name (Legal Business Name): AMANDA REAHARD RIZZARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W PARK ST
URBANA IL
61801-2367
US

IV. Provider business mailing address

4525 N RAVENSWOOD AVE # 201
CHICAGO IL
60640-5201
US

V. Phone/Fax

Practice location:
  • Phone: 217-337-3864
  • Fax:
Mailing address:
  • Phone: 312-878-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-144334
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberN1851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: