Provider Demographics
NPI:1457726770
Name:THOMAS KIZY MD PLLC
Entity type:Organization
Organization Name:THOMAS KIZY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-671-3190
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001-0477
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:329 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001
Practice Address - Country:US
Practice Address - Phone:810-671-3190
Practice Address - Fax:810-671-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI9460Medicare PIN