Healthcare Provider Details

I. General information

NPI: 1205497922
Provider Name (Legal Business Name): ALI WARIS RIZVI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 NEIL AVE
COLUMBUS OH
43201-2333
US

IV. Provider business mailing address

1664 NEIL AVE
COLUMBUS OH
43201-2333
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-6514
  • Fax:
Mailing address:
  • Phone: 614-293-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58.031166
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number34.018093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: