Basic Information
| Provider Information | |||||||||
| NPI: | 1689641664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIZK | ||||||||
| FirstName: | ABDALLAH | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S. BALLENGER HIGHWAY | ||||||||
| Address2: | PHYSICIAN BILLING/CREDENTIALING | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421591 | ||||||||
| Practice Location | |||||||||
| Address1: | 6815 DIXIE HWY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483462092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486251011 | ||||||||
| FaxNumber: | 2486251011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301086821 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1018247 | 01 | MI | MCLAREN HEALHT PLAN | OTHER | 17470 | 01 | MI | MCARE | OTHER | 4854611 | 05 | MI | MEDICAID | 01002723 | 01 | MI | GENESEE HEALTH PLAN | OTHER | 11OB510530 | 01 | MI | BCBSM | OTHER | 4817734 | 05 | MI | MEDICAID | 4852690 | 05 | MI | MEDICAID | 108247 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | POO284305 CJ6210 | 01 | MI | METRA HEALTH | OTHER | 110B510530 | 01 | MI | BLUE CHOICE/BCN/COMM BLUE | OTHER | I48615 | 01 | MI | HAP | OTHER |