MEDICARE: DR. MUNIR F RIZKALLAH 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	208000000X	Pediatrics Physician	ME43824	FL

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

General Provider Information

NPI Number	:	1952351850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUNIR F RIZKALLAH M.D.

Provider Business Mailing Address
First Line	:	1934 DATURA STREET
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34329
Country	:	US
Telephone Number	:	813-866-0930
Fax Number	:	813-866-0929

Provider Business Practice Location Address
First Line	:	1401 E 22ND AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-1837
Country	:	US
Telephone Number	:	813-248-6263
Fax Number	:	813-866-0929

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/18/2010

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