MEDICARE: FARHAT RIAZ

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	225X00000X	Occupational Therapist	5201008631	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1932682648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARHAT RIAZ

Provider Business Mailing Address
First Line	:	2093 LONG MEADOW DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3784
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2093 LONG MEADOW DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3784
Country	:	US
Telephone Number	:	317-319-7216
Fax Number	:

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

Provider Enumeration Date	:	09/09/2018
Last Update Date	:	06/11/2019

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Directions to “ FARHAT RIAZ ” Practice Location

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