Organization
MIDWEST ORAL AND MAXILLOFACIAL SURGERY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL L ICZKOVITZ DDS (PRESIDENT)
(260) 484-9990
Entity
Organization
Contact information
Practice address
516 N LINE ST, COLUMBIA CITY, IN 46725-1230
(260) 244-4007
Mailing address
3303 TRIER RD, FORT WAYNE, IN 46815-4768
(260) 484-9990
(260) 484-6573
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
54000677
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200147450
—
IN
Enumeration date
01/25/2007
Last updated
03/26/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up