Healthcare Provider Details

I. General information

NPI: 1548655152
Provider Name (Legal Business Name): BIANCA KIZY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30301 WOODWARD AVE STE 101
ROYAL OAK MI
48073-0981
US

IV. Provider business mailing address

30301 WOODWARD AVE STE 101
ROYAL OAK MI
48073-0981
US

V. Phone/Fax

Practice location:
  • Phone: 248-398-2525
  • Fax: 248-398-9286
Mailing address:
  • Phone: 248-398-2525
  • Fax: 248-398-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301500375
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: