Individual
MICHAEL L ICZKOVITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1121 W MICHIGAN ST, INDIANAPOLIS, IN 46202-5211
(317) 274-7433
(317) 274-2603
Mailing address
700 LANE 440 LAKE JAMES, ANGOLA, IN 46703-9090
(260) 348-4316
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12008664
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2901011066
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086698
BCBS/ANTHEM
IN
05
—
100079980
—
IN
Enumeration date
07/19/2006
Last updated
04/28/2026
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