Healthcare Provider Details

I. General information

NPI: 1457637506
Provider Name (Legal Business Name): THOMAS KIZY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 COLUMBIA ST
ALGONAC MI
48001
US

IV. Provider business mailing address

PO BOX 477
ALGONAC MI
48001-0477
US

V. Phone/Fax

Practice location:
  • Phone: 810-671-3190
  • Fax: 810-671-3263
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57.020167
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301106396
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: