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NPI Code Detail

MEDICARE: DR. NASSEEM FARHAN RIZKALLA MD

MEDICARE: DR. NASSEEM FARHAN RIZKALLA MD
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
1208600000XSurgery Physician044605MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30203641031OTHERMIBCBSM

General Provider Information

NPI Number : 1770699167
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NASSEEM FARHAN RIZKALLA MD
Provider Business Mailing Address
First Line : 1400 W ICE LAKE RD
Second Line :
City : IRON RIVER
State : MI
Zip : 49935-9526
Country : US
Telephone Number : 906-265-6121
Fax Number : 906-265-4245
Provider Business Practice Location Address
First Line : 1500 W ICE LAKE RD
Second Line :
City : IRON RIVER
State : MI
Zip : 49935-8509
Country : US
Telephone Number : 906-265-9001
Fax Number : 906-265-3056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 09/19/2013

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