Basic Information
| Provider Information | |||||||||
| NPI: | 1275718793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIZVI | ||||||||
| FirstName: | NESSREEN | ||||||||
| MiddleName: | SOBH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11650 BELLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481113380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865969385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11650 BELLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481113380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346999888 | ||||||||
| FaxNumber: | 7342931774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2008 | ||||||||
| LastUpdateDate: | 03/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301097600 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4301097600 | 01 | MI | STATE LICENSE # | OTHER | 1275718793 | 01 | MI | BCBS TYPE 1 (IND) NPI # | OTHER | 5315047914 | 01 | MI | CDS # | OTHER |