Provider Demographics
NPI:1922316389
Name:MIZERACKI, ADAM MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MILTON
Last Name:MIZERACKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 277894
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7894
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:866-347-1426
Practice Address - Street 1:2202 STATE AVE STE 303
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4590
Practice Address - Country:US
Practice Address - Phone:850-872-3939
Practice Address - Fax:850-872-3938
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
FLME142380207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease