Healthcare Provider Details

I. General information

NPI: 1699933499
Provider Name (Legal Business Name): STEVEN M MEZSICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 HOLY CROSS PARKWAY
MISHAWAKA IN
46545-1469
US

IV. Provider business mailing address

PO BOX 1742
SOUTH BEND IN
46634-1742
US

V. Phone/Fax

Practice location:
  • Phone: 574-233-3123
  • Fax: 574-233-3125
Mailing address:
  • Phone: 574-233-3123
  • Fax: 574-233-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01066359A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: