Provider Demographics
NPI:1437151115
Name:MIERZWIAK, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MIERZWIAK
Suffix:
Gender:M
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:PO BOX 633390
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3390
Mailing Address - Country:US
Mailing Address - Phone:800-594-1876
Mailing Address - Fax:
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056910207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720867Medicaid
OH000000246968OtherANTHEM
OH000000550248OtherANTHEM BLUE CROSS BLUE SHIELD
MI4488832Medicaid
OH000000550248OtherANTHEM BLUE CROSS BLUE SHIELD
MI4488832Medicaid
OHP00676870Medicare PIN
OH000000246968OtherANTHEM
OH930121169Medicare ID - Type UnspecifiedRAILROAD
OH0720867Medicaid