Provider Demographics
NPI:1457970576
Name:MITZKOVITZ, CAYLA
Entity Type:Individual
Prefix:
First Name:CAYLA
Middle Name:
Last Name:MITZKOVITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 E BLUE GRASS RD APT O6
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9833
Mailing Address - Country:US
Mailing Address - Phone:860-461-4497
Mailing Address - Fax:
Practice Address - Street 1:1280 E CAMPUS DR BLDG 1101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3803
Practice Address - Country:US
Practice Address - Phone:989-774-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
390200000XOtherDOCTORAL STUDENT