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Individual

MICHAEL R. MIZENKO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
777 BANNOCK ST, DENVER, CO 80204-4507
(614) 738-6442
Mailing address
777 BANNOCK ST, DENVER, CO 80204-4507
(614) 738-6442

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
34-004168
OH
2084P0800X
Psychiatry Physician
Primary
DR.0054317
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0635487
OH
01
111357000
MAGELLAN
OH
Enumeration date
03/19/2007
Last updated
03/11/2021
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