1508836172 NPI number — DR. SYED MOHSAN RIZVI MD

Table of content: DR. JAMES C MAGESTRO DDS (NPI 1821147067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508836172 NPI number — DR. SYED MOHSAN RIZVI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIZVI
Provider First Name:
SYED
Provider Middle Name:
MOHSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508836172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3245 HEALTH DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANGER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46530-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2235 CLEVELAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46628-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-647-4530
Provider Business Practice Location Address Fax Number:
574-647-2285
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  01072465A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000831429 . This is a "BCBS BMG SCHWARTZ-WIEKAMP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000856151 . This is a "BCBS BMG LAPORTE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000884798 . This is a "BCBS BMG ELKHART EAST" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P01371333 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 169380076 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201162730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000857581 . This is a "BCBS BMG GOSHEN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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