Organization
RIZWANA THANAWALA MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RIZWANA THANAWALA M.D (OWNER)
(386) 758-6094
Entity
Organization
Contact information
Practice address
4367 NW AMERICAN LN, LAKE CITY, FL 32055-4828
(386) 758-6094
(386) 758-6995
Mailing address
4367 NW AMERICAN LANE, LAKE CITY, FL 32055-4828
(386) 758-6094
(386) 758-6995
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266910200
—
FL
01
—
74502
BCBS GROUP ID
FL
Enumeration date
04/26/2007
Last updated
01/31/2011
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