Healthcare Provider Details

I. General information

NPI: 1649484429
Provider Name (Legal Business Name): RIZWANUL KABIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-2025
US

IV. Provider business mailing address

1564 KINGSLEY AVE
ORANGE PARK FL
32073-4521
US

V. Phone/Fax

Practice location:
  • Phone: 248-821-3178
  • Fax: 248-821-3178
Mailing address:
  • Phone: 904-264-0400
  • Fax: 904-264-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD438984
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME108908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: