Provider Demographics
NPI:1770570699
Name:MIZ, GEORGE S (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:MIZ
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 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:19550 GOVERNORS HWY STE 1400
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2136
Practice Address - Country:US
Practice Address - Phone:708-647-7565
Practice Address - Fax:708-225-7671
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062367207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-062367Medicaid
ILF400384564OtherMEDICARE
IL31601887OtherBCBS
IL31601887OtherBCBS
IL036062367Medicaid
D13424Medicare UPIN