MEDICARE: DR. PAULA MARIE OLEN-MIKRUT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	18135	AZ

General Provider Information

NPI Number	:	1023321627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA MARIE OLEN-MIKRUT M.D.

Provider Business Mailing Address
First Line	:	2390 E CAMELBACK RD
Second Line	:	SUITE 300
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3448
Country	:	US
Telephone Number	:	602-909-9551
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 E CAMELBACK RD
Second Line	:	SUITE 300
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3448
Country	:	US
Telephone Number	:	602-909-9551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	07/23/2010

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