Healthcare Provider Details

I. General information

NPI: 1891746533
Provider Name (Legal Business Name): KATHY JOYCE MIZE D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8145 N MILWAUKEE AVE
NILES IL
60714-2828
US

IV. Provider business mailing address

6442 S CASS AVE
WESTMONT IL
60559-3209
US

V. Phone/Fax

Practice location:
  • Phone: 847-470-0555
  • Fax: 847-470-0019
Mailing address:
  • Phone: 630-493-0600
  • Fax: 630-493-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016-005257
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-005257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: