Basic Information
| Provider Information | |||||||||
| NPI: | 1457637506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIZY | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 477 | ||||||||
| Address2: | |||||||||
| City: | ALGONAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480010477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107205715 | ||||||||
| FaxNumber: | 8107320891 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ALGONAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106713190 | ||||||||
| FaxNumber: | 8106713263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2011 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 57.020167 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301106396 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.