Provider Demographics
NPI:1255415352
Name:KIZILISIK, AYDIN T (MD)
Entity type:Individual
Prefix:
First Name:AYDIN
Middle Name:T
Last Name:KIZILISIK
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:MEDPARTNERS, ATTN: BARB COPELAND
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-435-6275
Practice Address - Fax:260-435-6279
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-12-27
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Provider Licenses
StateLicense IDTaxonomies
IN01062836A204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200861790Medicaid
IN200861790Medicaid
INM400036215Medicare PIN
IN149080NMedicare PIN