Organization
MICHAEL R. MIZENKO, D.O., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL R. MIZENKO D.O. (PRESIDENT)
(614) 421-7722
Entity
Organization
Contact information
Practice address
772 N HIGH ST, SUITE 201, COLUMBUS, OH 43215-1456
(614) 421-7722
(614) 421-7723
Mailing address
772 N HIGH ST, SUITE 201, COLUMBUS, OH 43215-1456
(614) 421-7722
(614) 421-7723
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
34004168
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111357000
MAGELLAN
OH
Enumeration date
04/16/2007
Last updated
07/17/2008
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