Healthcare Provider Details

I. General information

NPI: 1568138253
Provider Name (Legal Business Name): SALEH MIZYED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

11436 AUTUMN RIDGE DR
ORLAND PARK IL
60467-1343
US

V. Phone/Fax

Practice location:
  • Phone: 708-580-1235
  • Fax:
Mailing address:
  • Phone: 708-580-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209028654
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.456796
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28280014A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: