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1104399856
TIMOTHY DESMOND MIZDRAK
CHICAGO, IL
NPI
1104399856
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL 096.004715)
Enumeration Date
2019-01-05
Last Update Date
2019-01-05
Business Address
TIMOTHY DESMOND MIZDRAK ATC, LAT
1133 S STATE ST # B500
CHICAGO, IL 60605-2699
Phone number: 847-894-6221
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Mailing Address
TIMOTHY DESMOND MIZDRAK ATC, LAT
1133 S STATE ST # B500
CHICAGO, IL 60605-2699
Phone number: 847-894-6221
Copy
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