Healthcare Provider Details

I. General information

NPI: 1811933310
Provider Name (Legal Business Name): WILLIAM A MIZE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

PO BOX 46100
PLYMOUTH MN
55446-0100
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-8200
  • Fax:
Mailing address:
  • Phone: 763-553-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number36965
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36965
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: