Healthcare Provider Details

I. General information

NPI: 1457329567
Provider Name (Legal Business Name): EUGENE MIKNOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW SUITE 504
WASHINGTON DC
20036-3701
US

IV. Provider business mailing address

1145 19TH ST NW SUITE 504
WASHINGTON DC
20036-3701
US

V. Phone/Fax

Practice location:
  • Phone: 202-296-4002
  • Fax: 202-331-9365
Mailing address:
  • Phone: 202-296-4002
  • Fax: 202-331-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number16016
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: