MEDICARE: JAROSLAV PAUL MIKUS MD

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	207RC0000X	Cardiovascular Disease Physician	35041	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053396317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAROSLAV PAUL MIKUS MD

Provider Business Mailing Address
First Line	:	322 E CENTER ST
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1824
Country	:	US
Telephone Number	:	508-894-0400
Fax Number	:	508-565-3121

Provider Business Practice Location Address
First Line	:	322 E CENTER ST
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1824
Country	:	US
Telephone Number	:	508-894-0400
Fax Number	:	508-565-3121

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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