Healthcare Provider Details

I. General information

NPI: 1447634217
Provider Name (Legal Business Name): MAKI ISHIZUKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KY CHILDREN'S HOSPITAL 800 ROSE ST 4TH FL
LEXINGTON KY
40536-3056
US

IV. Provider business mailing address

7210 41ST AVE APT6J
WOODSIDE NY
11377-3056
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-0921
  • Fax: 859-257-1831
Mailing address:
  • Phone: 267-670-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number59982
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: