MEDICARE: IDA LOURDES MAZZA MD

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	174400000X	Specialist
2	207RC0000X	Cardiovascular Disease Physician	ME133355	FL
3	207RC0000X	Cardiovascular Disease Physician	MD419073	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518953850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDA LOURDES MAZZA MD

Provider Business Mailing Address
First Line	:	711 N SIOUX POINT RD
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-5099
Country	:	US
Telephone Number	:	712-294-7468
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 N SIOUX POINT RD
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-5099
Country	:	US
Telephone Number	:	712-294-7468
Fax Number	:

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	01/29/2024

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Directions to “ IDA LOURDES MAZZA MD” Practice Location

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