Healthcare Provider Details

I. General information

NPI: 1063855286
Provider Name (Legal Business Name): FARHAAD RAHMAN RIYAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3677 FORT ST
LINCOLN PARK MI
48146-4116
US

IV. Provider business mailing address

48766 STONERIDGE DR
NORTHVILLE MI
48168-8675
US

V. Phone/Fax

Practice location:
  • Phone: 313-312-9069
  • Fax:
Mailing address:
  • Phone: 804-991-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301502950
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.140316
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number4301502950
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number4301502950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: