Individual
LAKSHMI D MIZIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
187 FALLBROOK ST, CARBONDALE, PA 18407-1861
(570) 282-5189
(570) 282-5551
Mailing address
187 FALLBROOK ST, P O BOX 577, CARBONDALE, PA 18407-1861
(570) 282-5189
(570) 282-5551
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD024661E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010040040004
—
PA
Enumeration date
12/29/2005
Last updated
04/25/2012
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