Healthcare Provider Details

I. General information

NPI: 1245294065
Provider Name (Legal Business Name): GEORGE J MIKOS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 KRESGE WAY STE 103
LOUISVILLE KY
40207
US

IV. Provider business mailing address

2301 RIVER RD #300
LOUISVILLE KY
40206
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-2667
  • Fax: 502-895-4919
Mailing address:
  • Phone: 502-814-3175
  • Fax: 502-426-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE J MIKOS
Title or Position: OWNER MD
Credential: MD
Phone: 502-895-4919