MEDICARE: RIZWAN ALI M.D

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	208M00000X	Hospitalist Physician	29105	WV
2	207R00000X	Internal Medicine Physician	302226	LA
3	207R00000X	Internal Medicine Physician	S2210	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588005276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIZWAN ALI M.D

Provider Business Mailing Address
First Line	:	PO BOX 540088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19701 KINGWOOD DR STE 9
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3775
Country	:	US
Telephone Number	:	304-435-7553
Fax Number	:

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

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	11/29/2023

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