Healthcare Provider Details

I. General information

NPI: 1396164570
Provider Name (Legal Business Name): MITCHELL IZOWER BS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # SPAN2
BOSTON MA
02215-5400
US

IV. Provider business mailing address

484 MASSACHUSETTS AVE APT 1
BOSTON MA
02118-1135
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-4677
  • Fax:
Mailing address:
  • Phone: 201-248-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number270088
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: