Healthcare Provider Details

I. General information

NPI: 1336989334
Provider Name (Legal Business Name): MIKOLAS CARL HONOMICHL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIK CARL HONOMICHL

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SUNSET AVE
MANHATTAN KS
66502-3739
US

IV. Provider business mailing address

9837 POST OAK DR
DE SOTO KS
66018-9307
US

V. Phone/Fax

Practice location:
  • Phone: 913-293-7006
  • Fax:
Mailing address:
  • Phone: 913-293-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: