Provider Demographics
NPI:1790311025
Name:MROZIK, MITCHELL PAUL (MS, RD)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:PAUL
Last Name:MROZIK
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 STATESMAN CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2685
Mailing Address - Country:US
Mailing Address - Phone:616-405-6840
Mailing Address - Fax:
Practice Address - Street 1:3308 STATESMAN CT NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2685
Practice Address - Country:US
Practice Address - Phone:616-405-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered