Healthcare Provider Details

I. General information

NPI: 1689530966
Provider Name (Legal Business Name): ABBEY MIKUTAICIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N CALVERT ST
BALTIMORE MD
21218-2867
US

IV. Provider business mailing address

544 CARROLLWOOD RD APT C
MIDDLE RIVER MD
21220-3126
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-5405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: