Individual
KATHERINE MONTAGUE MIZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
700 CHILDREN'S DRIVE, COLUMBUS, OH 43205-2664
(614) 722-3100
(614) 722-2549
Mailing address
700 CHILDREN'S DRIVE, COLUMBUS, OH 43205-2664
(614) 722-3100
(614) 722-2549
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
35078529
OH
2080P0203X
Pediatric Critical Care Medicine Physician
35078529
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1802977000
—
WV
05
—
2211403
—
OH
05
—
64027246
—
KY
01
—
MI4040601
MEDICARE
OH
01
—
MI4040602
MEDICARE
OH
Enumeration date
09/06/2005
Last updated
01/21/2016
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