Provider Demographics
NPI:1003026139
Name:MIZESKO, MELISSA CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CATHERINE
Last Name:MIZESKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 S. ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-694-4864
Mailing Address - Fax:361-851-6867
Practice Address - Street 1:3533 S. ALAMEDA
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-694-4864
Practice Address - Fax:361-851-6867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP78142080P0216X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3276750-03Medicaid
TX3276750-03Medicaid