Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 01085567A | IN |
NPI | 1194088567 |
---|---|
Provider Name | Kristin Tompkins Mizerik |
First Address | Fort Wayne, IN 46801-2526 |
Second Address | Fort Wayne, IN 46804-4133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300049470 | (05) | IN |