Provider Demographics
NPI:1730184086
Name:HIZON, MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:HIZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W COURT ST
Mailing Address - Street 2:STE 304
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3694
Mailing Address - Country:US
Mailing Address - Phone:815-933-4422
Mailing Address - Fax:815-933-4446
Practice Address - Street 1:455 W COURT ST
Practice Address - Street 2:STE 304
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3694
Practice Address - Country:US
Practice Address - Phone:815-933-4422
Practice Address - Fax:815-933-4446
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IL036069883207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069883Medicaid
ILL06871Medicaid
IL269961Medicare ID - Type UnspecifiedMEDICARE
ILL06871Medicaid