Basic Information
| Provider Information | |||||||||
| NPI: | 1730683038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISHTIAQ | ||||||||
| FirstName: | RIZWAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MERCY ST. VINCENT MEDICAL CENTER | ||||||||
| Address2: | 2213 CHERRY STREET | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192514554 | ||||||||
| FaxNumber: | 4192516795 | ||||||||
| Practice Location | |||||||||
| Address1: | MERCY FAMILY CARE CENTER | ||||||||
| Address2: | 2213 FRANKLIN AVE | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192512360 | ||||||||
| FaxNumber: | 4192512393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 67555 | CT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.