Individual
MARILYN SUZANNE MIZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5002
(740) 446-5883
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5002
(740) 446-5883
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
13777
WV
207RC0000X
Cardiovascular Disease Physician
Primary
35-047722
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006897
ANTHEM BCBS
—
01
—
000000185191
UNISON MEDICAID
OH
01
—
001714031
MOUNTAIN STATE BCBS
—
05
—
0083707000
—
WV
01
—
0489716
MOLINA MEDICAID
OH
01
—
060018483
RR MEDICARE
—
01
—
310917085035
CARESOURCE MEDICAID
OH
Enumeration date
05/20/2006
Last updated
02/06/2015
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