Healthcare Provider Details

I. General information

NPI: 1316385859
Provider Name (Legal Business Name): ROBERT A. MIKAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR ROOM 5867
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

531 VIRGINIA AVE UNIT 106
INDIANAPOLIS IN
46203-1790
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-4034
  • Fax: 317-944-1476
Mailing address:
  • Phone: 937-581-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11017273A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: