Healthcare Provider Details

I. General information

NPI: 1609891753
Provider Name (Legal Business Name): MAGED M RIZK M.D.,PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 BENDING CT
FLUSHING MI
48433-3019
US

IV. Provider business mailing address

754 BENDING CT
FLUSHING MI
48433-3019
US

V. Phone/Fax

Practice location:
  • Phone: 810-867-4883
  • Fax: 810-867-4883
Mailing address:
  • Phone: 810-867-4883
  • Fax: 810-867-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301078844
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35-094037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: