Healthcare Provider Details

I. General information

NPI: 1780392985
Provider Name (Legal Business Name): RUBY RIZWAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41800 W 11 MILE RD STE 110
NOVI MI
48375-1818
US

IV. Provider business mailing address

50649 HESPERUS
CANTON MI
48187-7718
US

V. Phone/Fax

Practice location:
  • Phone: 877-693-5543
  • Fax: 248-221-1775
Mailing address:
  • Phone: 734-516-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022213
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: