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General NPI Number Information
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NPI Number | 1770570699
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Entity Type | Individual
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Provider Name | GEORGE S MIZ MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 19550 GOVERNORS HWY STE 1400
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2136
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Country | US
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Telephone | 708-647-7565
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Fax | 708-225-7671
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Provider Business Mailing Address
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Address Line | 27702 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1277
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Country | US
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Telephone | 708-862-7674
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Fax | 708-862-1781
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036062367
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License Number State | IL
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