Healthcare Provider Details

I. General information

NPI: 1760644439
Provider Name (Legal Business Name): JOSHUA JAMES MIKSANEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 14TH ST
HERRIN IL
62948-3631
US

IV. Provider business mailing address

PO BOX 1467
INDIANAPOLIS IN
46206-1467
US

V. Phone/Fax

Practice location:
  • Phone: 618-942-2171
  • Fax: 618-988-6186
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.127538
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036127538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: