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General NPI Number Information
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NPI Number | 1518182666
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Entity Type | Organization
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Legal Business Name | MICHAEL R. MIZENKO, D.O., INC.
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 772 N HIGH ST SUITE 201
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City | COLUMBUS
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State | OH
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Zip | 43215-1456
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Country | US
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Telephone | 614-421-7722
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Fax | 614-421-7723
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Provider Business Mailing Address
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Address Line | 772 N HIGH ST SUITE 201
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City | COLUMBUS
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State | OH
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Zip | 43215-1456
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Country | US
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Telephone | 614-421-7722
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Fax | 614-421-7723
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL R. MIZENKO
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Credential | D.O.
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Telephone | 614-421-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34004168
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License Number State | OH
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