NPIMap

Individual provider Active NPI

Tito Lamont Izard, M.D.

  • Family Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1013947662
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39584-20 Issued in WI
Practice address
2555 N Dr Martin Luther King Jr Dr
Milwaukee, WI 53212-2709
Phone
(414) 372-8080
Fax
(414) 464-6321
NPI assigned
Jul 3, 2006
Last updated
Jul 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39584-20 WI Primary

Addresses

Primary practice location

2555 N Dr Martin Luther King Jr Dr
Milwaukee, WI 53212-2709

Mailing address

2555 N Martin Luther King Dr
Milwaukee Health Services Inc
Milwaukee, WI 53212-2709
Phone (414) 372-8080

Other practice location 1

8200 W Silver Spring Dr
Milwaukee, WI 53218-2552
Phone (414) 760-3900

Other identifiers 1

IdentifierTypeStateIssuer
32607000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040120000346 WI Practitioner - Family Practice 1850292012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Milwaukee Health Services, Inc.Group PAC ID 7416946884, 27 clinicians

Practice addresses (Care Compare)

2555 N Dr Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone (414) 372-8080

2555 N Dr Martin Luther King Jr Dr
Milwaukee, WI 53212-2709

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Milwaukee Health Services Inc CurrentSince Jan 16, 2006 Accepting new patients
Milwaukee Health Services, Inc. Current Accepting new patients
Milwaukee Health Services, Inc. CurrentSince Jan 16, 2006 Accepting new patients

Locations

2555 N Mlk Dr
Milwaukee, WI 53212
Phone (414) 267-2022

8200 W Silver Spring Dr
Milwaukee, WI 53218
Phone (414) 760-3900

Interoperability endpoints

  • Direct secure messaging: tizard526462@direct.ochin.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Martin Luther King Heritage Health CenterMilwaukee, WI, CCN 521829 Federally qualified health center Corporate Officer
W-2 Managing Employee		 May 1, 2011
May 1, 2019
Isaac Coggs Heritage Health CenterMilwaukee, WI, CCN 521804 Federally qualified health center Corporate Officer
W-2 Managing Employee (100%)		 Jan 17, 2006
Jan 17, 2006

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1013947662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "address_2": "MILWAUKEE HEALTH SERVICES INC",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-372-8080",
            "fax_number": "414-372-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 N DR MARTIN LUTHER KING JR DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-372-8080",
            "fax_number": "414-464-6321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8200 W Silver Spring Dr",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532182552",
            "country_code": "US",
            "telephone_number": "414-760-3900",
            "fax_number": "414-464-6321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IZARD",
        "first_name": "TITO",
        "middle_name": "LAMONT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "39584-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32607000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.