Individual
NANA N MIZUGUCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2341 LIME KILN LANE, LOUISVILLE, KY 40222
(502) 899-9979
(502) 899-9939
Mailing address
2341 LIME KILN LANE, LOUISVILLE, KY 40222
(502) 899-9979
(502) 899-9939
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
33262
KY
208600000X
Surgery Physician
33262
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200439580
INDIANA MEDICAID
IN
05
—
200439580
—
IN
05
—
64064777
—
KY
Enumeration date
01/18/2006
Last updated
03/13/2014
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