Healthcare Provider Details

I. General information

NPI: 1023321627
Provider Name (Legal Business Name): PAULA MARIE OLEN-MIKRUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 E CAMELBACK RD SUITE 300
PHOENIX AZ
85016-3448
US

IV. Provider business mailing address

2390 E CAMELBACK RD SUITE 300
PHOENIX AZ
85016-3448
US

V. Phone/Fax

Practice location:
  • Phone: 602-909-9551
  • Fax:
Mailing address:
  • Phone: 602-909-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18135
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: