Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 269250 | NY |
Y | 207VX0201X | Gynecologic Oncologist | 4301109498 | MI |
NPI | 1134354954 |
---|---|
Provider Name | Dr. Benjamin Baines Mize |
First Address | Kalamazoo, MI 49007-3731 |
Second Address | Kalamazoo, MI 49007-3731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2009 |
Last Update Date | 10/06/2016 |