Healthcare Provider Details

I. General information

NPI: 1851396964
Provider Name (Legal Business Name): LOUIS MIZELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 E 5900 S STE A112
MURRAY UT
84107-7274
US

IV. Provider business mailing address

164 E 5900 S STE A112
MURRAY UT
84107-7274
US

V. Phone/Fax

Practice location:
  • Phone: 385-478-8975
  • Fax: 801-269-9894
Mailing address:
  • Phone: 385-478-8975
  • Fax: 801-269-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number168364-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number82-168364-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: