Basic Information
| Provider Information | |||||||||
| NPI: | 1013215474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GILES B. MIZOCK M.D. LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2587 FAIRFORD LANE | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60062 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5025 W. PAULINA | ||||||||
| Address2: | METHODIST HOSP | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732719040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2011 | ||||||||
| LastUpdateDate: | 03/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | MIZOCK | ||||||||
| AuthorizedOfficialFirstName: | GILES | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8475090547 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036-035966 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.