Healthcare Provider Details

I. General information

NPI: 1710812821
Provider Name (Legal Business Name): ROBERT MICHAEL MIKOL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 OLD STEESE HWY
FAIRBANKS AK
99701-3126
US

IV. Provider business mailing address

PO BOX 80106
FAIRBANKS AK
99708-0106
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-7246
  • Fax:
Mailing address:
  • Phone: 907-750-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number256014
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: