Basic Information
| Provider Information | |||||||||
| NPI: | 1518938901 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIZAL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 W COLUMBIA ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477101782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124254646 | ||||||||
| FaxNumber: | 8124677209 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 W COLUMBIA ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477101782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124254646 | ||||||||
| FaxNumber: | 8124677209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 07/15/2010 | ||||||||
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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 | 207Y00000X | 01020747A | IN | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 100045320 | 05 | IN | MEDICAID |