1336254887 NPI number — DR. KATHARINE H MIKULEC M.D.

Table of content: DR. KATHARINE H MIKULEC M.D. (NPI 1336254887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336254887 NPI number — DR. KATHARINE H MIKULEC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIKULEC
Provider First Name:
KATHARINE
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336254887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 SAINT LUKES CENTER DR
Provider Second Line Business Mailing Address:
SUITE 504
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-205-6633
Provider Business Mailing Address Fax Number:
314-523-2798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 SAINT LUKES CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-205-6633
Provider Business Practice Location Address Fax Number:
314-523-2798
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  2004019693 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 841682728 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1336254887 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DP1487 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1306088182 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00733645 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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