Provider Demographics
NPI:1013947662
Name:IZARD, TITO LAMONT (MD)
Entity Type:Individual
Prefix:
First Name:TITO
Middle Name:LAMONT
Last Name:IZARD
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 1:2555 N MARTIN LUTHER KING DR
Mailing Address - Street 2:MILWAUKEE HEALTH SERVICES INC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2709
Mailing Address - Country:US
Mailing Address - Phone:414-372-8080
Mailing Address - Fax:414-372-1705
Practice Address - Street 1:2555 N MARTIN LUTHER KING DR
Practice Address - Street 2:MILWAUKEE HEALTH SERVICES INC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2709
Practice Address - Country:US
Practice Address - Phone:414-372-8080
Practice Address - Fax:414-372-1705
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI39584-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32607000Medicaid
G77404Medicare UPIN