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1710172515

NPI Code Detail

MEDICARE: ALEXANDER MAZUR MD

MEDICARE: ALEXANDER MAZUR MD

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	207R00000X	Internal Medicine Physician	37476	IA
2	207RC0000X	Cardiovascular Disease Physician	37476	IA
3	207RI0011X	Interventional Cardiology Physician	37476	IA
4	207RC0001X	Clinical Cardiac Electrophysiology Physician	37476	IA
5	207RC0001X	Clinical Cardiac Electrophysiology Physician	036123579	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71363	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1710172515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER MAZUR MD

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 1159
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3883
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 1159
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3883
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:

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

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	05/24/2022

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Directions to “ ALEXANDER MAZUR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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