Provider Demographics
NPI:1619210622
Name:LOMIZE, MIKHAIL ANDREEVICH (DO)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:ANDREEVICH
Last Name:LOMIZE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N LEE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1036
Mailing Address - Country:US
Mailing Address - Phone:405-272-6406
Mailing Address - Fax:405-272-6075
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-6406
Practice Address - Fax:405-272-6075
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61286225207Q00000X
OK5656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine