Provider Demographics
NPI:1912958810
Name:RIFAI, TOM (MD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:RIFAI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE L-4000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:248-845-2120
Mailing Address - Fax:248-282-5350
Practice Address - Street 1:9500 EUCLID AVE # F20
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5031
Practice Address - Country:US
Practice Address - Phone:216-444-6568
Practice Address - Fax:248-445-1656
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076062132700000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No132700000XDietary & Nutritional Service ProvidersDietary Manager
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M02170Medicare PIN
MIH84909Medicare UPIN