MEDICARE: THE RIAZ CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1073225181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RIAZ CLINIC

Provider Business Mailing Address
First Line	:	3342 NE 34TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6906
Country	:	US
Telephone Number	:	954-358-2363
Fax Number	:	954-306-2232

Provider Business Practice Location Address
First Line	:	3342 NE 34TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6906
Country	:	US
Telephone Number	:	954-358-2363
Fax Number	:	954-306-2232

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	AHMED RIAZ
Credential	:	DO
Telephone Number	:	305-495-9560

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	12/20/2022

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Directions to “THE RIAZ CLINIC ” Practice Location

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