Provider Demographics
NPI:1356370803
Name:MIZES, CRAIG B (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:MIZES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1072
Mailing Address - Country:US
Mailing Address - Phone:989-872-5582
Mailing Address - Fax:
Practice Address - Street 1:6190 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1072
Practice Address - Country:US
Practice Address - Phone:989-872-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5584208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175019001Medicaid
A53176Medicare UPIN
AR5H117Medicare PIN