Healthcare Provider Details

I. General information

NPI: 1568702116
Provider Name (Legal Business Name): RIZWAN M MUFTI, MD., PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26631 SOUTHFIELD RD
LATHRUP VILLAGE MI
48076-4530
US

IV. Provider business mailing address

35379 NORTHMONT DR
FARMINGTON HILLS MI
48331-2648
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-8195
  • Fax: 248-552-8537
Mailing address:
  • Phone: 248-986-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RIZWAN MEHMOOD MUFTI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-986-7500