Healthcare Provider Details

I. General information

NPI: 1477130862
Provider Name (Legal Business Name): MELISSA EMILY MIZERIK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA EMILY SCHULLEK

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ # BCM320
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

1 BAYLOR PLZ # BCM320
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: