Individual
TIMOTHY DESMOND MIZDRAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1133 S STATE ST # B500, CHICAGO, IL 60605-2699
(847) 894-6221
Mailing address
1133 S STATE ST # B500, CHICAGO, IL 60605-2699
(847) 894-6221
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004715
IL
Other
Enumeration date
01/05/2019
Last updated
01/05/2019
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