Healthcare Provider Details

I. General information

NPI: 1770570699
Provider Name (Legal Business Name): GEORGE S MIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 GOVERNORS HWY STE 1400
FLOSSMOOR IL
60422-2136
US

IV. Provider business mailing address

27702 NETWORK PL
CHICAGO IL
60673-1277
US

V. Phone/Fax

Practice location:
  • Phone: 708-647-7565
  • Fax: 708-225-7671
Mailing address:
  • Phone: 708-862-7674
  • Fax: 708-862-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036062367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: