Healthcare Provider Details

I. General information

NPI: 1740244243
Provider Name (Legal Business Name): MARK S MIZEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CRANDON BLVD APT F403
KEY BISCAYNE FL
33149-2779
US

IV. Provider business mailing address

1121 CRANDON BLVD APT F403
KEY BISCAYNE FL
33149-2779
US

V. Phone/Fax

Practice location:
  • Phone: 305-365-5262
  • Fax:
Mailing address:
  • Phone: 305-365-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME41307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: