Basic Information
| Provider Information | |||||||||
| NPI: | 1457726770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS KIZY MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 477 | ||||||||
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| 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: | 12/11/2015 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | KIZY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8106713190 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.