Healthcare Provider Details

I. General information

NPI: 1770993511
Provider Name (Legal Business Name): NINA MIKKILINENI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7804
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-2712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberDR.0064425
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: