Basic Information
Provider Information
NPI: 1477044196
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIZVYDEEN
FirstName: SAAJIDHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
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Mailing Information
Address1: 180 HARVESTER DR STE 110
Address2:  
City: BURR RIDGE
State: IL
PostalCode: 605276686
CountryCode: US
TelephoneNumber: 7737021150
FaxNumber:  
Practice Location
Address1: 5841 S MARYLAND AVE # MC6060
Address2:  
City: CHICAGO
State: IL
PostalCode: 606371443
CountryCode: US
TelephoneNumber: 7737026210
FaxNumber: 7737020764
Other Information
ProviderEnumerationDate: 05/29/2018
LastUpdateDate: 07/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080N0001X036.155422ILY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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