Healthcare Provider Details

I. General information

NPI: 1134354954
Provider Name (Legal Business Name): BENJAMIN BAINES MIZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

IV. Provider business mailing address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-2500
  • Fax: 269-384-8617
Mailing address:
  • Phone: 269-382-2500
  • Fax: 269-384-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number269250
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number4301109498
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: