Healthcare Provider Details

I. General information

NPI: 1619397197
Provider Name (Legal Business Name): RILIWANU ALIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 SHERRY AVE
PARK FALLS WI
54552-1412
US

IV. Provider business mailing address

3589 BARTOWS BRG
POWDER SPRINGS GA
30127-9001
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2484
  • Fax:
Mailing address:
  • Phone: 706-842-4398
  • Fax: 706-723-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18378
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number72087
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72087
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number077517
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036167273
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: