Provider Demographics
NPI:1891746533
Name:MIZE, KATHY JOYCE (DPM)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JOYCE
Last Name:MIZE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3209
Mailing Address - Country:US
Mailing Address - Phone:630-493-0600
Mailing Address - Fax:630-493-0686
Practice Address - Street 1:8145 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2828
Practice Address - Country:US
Practice Address - Phone:847-470-0555
Practice Address - Fax:847-470-0019
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005257213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632760OtherBLUE CROSS BLUE SHIELD
IL016005257Medicaid
ILP00467322OtherRAILROAD MEDICARE
ILK35837Medicare PIN
ILK31296Medicare PIN
IL4755700001Medicare NSC
IL4755700002Medicare NSC