Provider Demographics
NPI:1285126656
Name:RIZVI, ABBAS ALI (DO)
Entity type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:ALI
Last Name:RIZVI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 955
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3862
Mailing Address - Country:US
Mailing Address - Phone:312-942-7030
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 955
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3862
Practice Address - Country:US
Practice Address - Phone:312-942-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023943207Q00000X
IL036.156145207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine