MEDICARE: KIM & MIZERA SURGICAL ASSOCIATES SC

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	036097666	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	213876	OTHER	IL	GROUP PTIN

General Provider Information

NPI Number	:	1831109313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM & MIZERA SURGICAL ASSOCIATES SC

Provider Business Mailing Address
First Line	:	5140 N CALIFORNIA AVE STE 560
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2577
Country	:	US
Telephone Number	:	773-275-4496
Fax Number	:	773-784-6141

Provider Business Practice Location Address
First Line	:	5140 N CALIFORNIA AVE STE 560
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2577
Country	:	US
Telephone Number	:	773-275-4496
Fax Number	:	773-784-6141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN S. KIM
Credential	:	M.D.
Telephone Number	:	773-275-4496

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	05/24/2010

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Directions to “KIM & MIZERA SURGICAL ASSOCIATES SC ” Practice Location

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