Basic Information
| Provider Information | |||||||||
| NPI: | 1023075199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIZZI | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3205 154TH STREET | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152269810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12368 STRATFORD DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152269810 | ||||||||
| FaxNumber: | 5152268408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 36486 | IA | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
ID Information
| ID | Type | State | Issuer | Description | 9478206 | 05 | IA | MEDICAID |