Healthcare Provider Details

I. General information

NPI: 1104752203
Provider Name (Legal Business Name): NATALIYA MIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007643
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: