Basic Information
| Provider Information | |||||||||
| NPI: | 1063412807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIZVI | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | HASSAN MEHDI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 FROSTWOOD DR STE 142 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138278266 | ||||||||
| FaxNumber: | 7138270132 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 FROSTWOOD DR STE 142 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138278266 | ||||||||
| FaxNumber: | 7138270132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | K7601 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 760465919 | 01 | TX | TAX ID | OTHER | 149432002 | 05 | TX | MEDICAID | 167227101 | 05 | TX | MEDICAID | 1083861231 | 01 | TX | NPI | OTHER |