Healthcare Provider Details

I. General information

NPI: 1770699167
Provider Name (Legal Business Name): NASSEEM FARHAN RIZKALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ICE LAKE RD
IRON RIVER MI
49935-8509
US

IV. Provider business mailing address

1400 W ICE LAKE RD
IRON RIVER MI
49935-9526
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-9001
  • Fax: 906-265-3056
Mailing address:
  • Phone: 906-265-6121
  • Fax: 906-265-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number044605
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: