Provider Demographics
NPI:1437209178
Name:BIZIOS, MARY (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BIZIOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S GARY AVE
Mailing Address - Street 2:#204
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108
Mailing Address - Country:US
Mailing Address - Phone:630-894-7505
Mailing Address - Fax:630-894-6552
Practice Address - Street 1:245 S GARY AVE
Practice Address - Street 2:#204
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:630-894-7505
Practice Address - Fax:630-894-6552
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16172Medicare UPIN