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NPI Code Detail

MEDICARE: MADISON MIZELL PA-C

MEDICARE: MADISON MIZELL PA-C
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
1363AM0700XMedical Physician Assistant
2363A00000XPhysician Assistant338343LA

General Provider Information

NPI Number : 1396423968
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON MIZELL PA-C
Provider Business Mailing Address
First Line : 1514 JEFFERSON HWY
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70121-2429
Country : US
Telephone Number : 504-842-4000
Fax Number :
Provider Business Practice Location Address
First Line : 111 ALLEN TOUSSAINT BLVD STE C
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70124-2588
Country : US
Telephone Number : 504-286-2001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2023
Last Update Date : 09/20/2023

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Directions to “ MADISON MIZELL PA-C” Practice Location

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