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NPI Code Detail

MEDICARE: DR. MARIA MIKOLAENKO DO

MEDICARE: DR. MARIA MIKOLAENKO DO
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
1207QA0505XAdult Medicine PhysicianOS15147FL
2207QA0505XAdult Medicine Physician66720CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OS15147OTHERFLSTATE LICENSE

General Provider Information

NPI Number : 1063824761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIA MIKOLAENKO DO
Provider Business Mailing Address
First Line : 1290 SILAS DEANE HWY
Second Line :
City : WETHERSFIELD
State : CT
Zip : 06109-4337
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2979 MAIN ST
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06606-4284
Country : US
Telephone Number : 203-382-2345
Fax Number : 203-366-0868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2014
Last Update Date : 10/02/2020

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Directions to “ DR. MARIA MIKOLAENKO DO” Practice Location

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