Individual
MRS. MIRA N SLIZOVSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
915 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1443
(765) 463-5252
(765) 463-2289
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01094049A
IN
208000000X
Pediatrics Physician
MD065630L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017085760001
—
PA
Enumeration date
04/21/2006
Last updated
10/07/2024
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