Provider Demographics
NPI:1114937687
Name:MIZERA, CECYLIA K (MD)
Entity type:Individual
Prefix:
First Name:CECYLIA
Middle Name:K
Last Name:MIZERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 N. CALIFORNIA AVE.
Mailing Address - Street 2:SUITE 560-GMP
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-293-8878
Mailing Address - Fax:773-293-8879
Practice Address - Street 1:5140 N CALIFORNIA AVE STE 560
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2577
Practice Address - Country:US
Practice Address - Phone:773-275-4496
Practice Address - Fax:773-784-6141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110827208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110827Medicaid