Individual
ERIC MIZUNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2720 W DIVISION ST, CHICAGO, IL 60622-2853
(773) 523-8600
(773) 687-9545
Mailing address
PO BOX 3603, OAK BROOK, IL 60522-3603
(773) 523-8600
(773) 687-9545
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-082731
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-082731
—
IL
01
—
10640555
CAQH
IL
01
—
F400186347
MEDICARE
IL
01
—
QXIPQ0000100695
AETNA BETTER HEALTH
IL
Enumeration date
06/27/2006
Last updated
03/07/2023
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