Healthcare Provider Details

I. General information

NPI: 1275625006
Provider Name (Legal Business Name): MILOSLAVA SOUCKOVA MICIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILA MICIAN MD

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 W WATERS AVENUE
TAMPA FL
33614
US

IV. Provider business mailing address

3619 W WATERS AVENUE
TAMPA FL
33614
US

V. Phone/Fax

Practice location:
  • Phone: 813-932-8866
  • Fax: 813-932-9668
Mailing address:
  • Phone: 813-932-8866
  • Fax: 813-932-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME0029781
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME0029781
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0029781
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME0029781
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME0029781
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME0029781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: