MEDICARE: CECYLIA K. MIZERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036110827	IL
2	2086X0206X	Surgical Oncology Physician	036110827	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114937687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECYLIA K. MIZERA M.D.

Provider Business Mailing Address
First Line	:	5140 N. CALIFORNIA AVE.
Second Line	:	SUITE 560-GMP
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:	773-293-8878
Fax Number	:	773-293-8879

Provider Business Practice Location Address
First Line	:	5140 N CALIFORNIA AVE STE 560
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2577
Country	:	US
Telephone Number	:	773-275-4496
Fax Number	:	773-784-6141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	11/16/2023

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Directions to “ CECYLIA K. MIZERA M.D.” Practice Location

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