MEDICARE: MAX RIZER D.O.

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	208800000X	Urology Physician	5101013919	MI

General Provider Information

NPI Number	:	1275513079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX RIZER D.O.

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE # MC845
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 ATKINSON DR STE 200
Second Line	:
City	:	LUDINGTON
State	:	MI
Zip	:	49431-1917
Country	:	US
Telephone Number	:	231-843-3717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	02/22/2021

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