Healthcare Provider Details

I. General information

NPI: 1306004460
Provider Name (Legal Business Name): RIZWAN ASLAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE SL-59
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE SL 59
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5454
  • Fax: 504-988-7846
Mailing address:
  • Phone: 504-988-5454
  • Fax: 504-988-7846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number34.009560
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberDO.000218
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: