Individual
RONALD MOCHIZUKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1256
(708) 923-5055
(708) 923-5058
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-8283
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036078225
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01620954
BLUE SHIELD
IL
05
—
036078225
—
IL
01
—
250008036
RAILROAD MEDICARE
—
Enumeration date
10/11/2005
Last updated
08/26/2009
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