Healthcare Provider Details

I. General information

NPI: 1417914623
Provider Name (Legal Business Name): WILLIAM MIZIKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BROADWAY ST
QUINCY IL
62301-3713
US

IV. Provider business mailing address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6550
  • Fax:
Mailing address:
  • Phone: 412-359-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD060536L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036152389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: