Provider Demographics
NPI:1710028311
Name:BIZEK, JOSEPH L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:BIZEK
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 1:500 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-2365
Mailing Address - Country:US
Mailing Address - Phone:417-678-2122
Mailing Address - Fax:417-678-7877
Practice Address - Street 1:500 PORTER AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2365
Practice Address - Country:US
Practice Address - Phone:417-678-2122
Practice Address - Fax:417-678-7877
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6113208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO83752OtherAR BLUE SHIELD #
MO207519208Medicaid
MO83752OtherAR BLUE SHIELD #
MOA10934Medicare UPIN
MO207519208Medicaid