MEDICARE: CRAIG B MIZES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	E5584	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356370803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG B MIZES M.D.

Provider Business Mailing Address
First Line	:	6190 HOSPITAL DR
Second Line	:
City	:	CASS CITY
State	:	MI
Zip	:	48726-1072
Country	:	US
Telephone Number	:	989-872-5582
Fax Number	:

Provider Business Practice Location Address
First Line	:	6190 HOSPITAL DR
Second Line	:
City	:	CASS CITY
State	:	MI
Zip	:	48726-1072
Country	:	US
Telephone Number	:	989-872-5582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/30/2021

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