Provider Demographics
NPI:1932166956
Name:BIZIK, BRIAN KEITH (PA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:BIZIK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FALLS AVENUE, SUITE 2
Mailing Address - Street 2:ASTHMA & ALERGY OF IDAHO
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-734-6091
Mailing Address - Fax:208-734-4654
Practice Address - Street 1:800 FALLS AVENUE, SUITE 2
Practice Address - Street 2:ASTHMA & ALERGY OF IDAHO
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-6091
Practice Address - Fax:208-734-4654
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-453363A00000X
ID363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP98724Medicare UPIN