Healthcare Provider Details

I. General information

NPI: 1134992217
Provider Name (Legal Business Name): LINA RIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 PLYMOUTH RD
ANN ARBOR MI
48105-2550
US

IV. Provider business mailing address

19700 HERON PASS
BROOKFIELD WI
53045-8140
US

V. Phone/Fax

Practice location:
  • Phone: 734-995-7300
  • Fax:
Mailing address:
  • Phone: 724-579-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.012077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: