Healthcare Provider Details

I. General information

NPI: 1154278554
Provider Name (Legal Business Name): JOSHUA MIKOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10842 ALAMEDA AVE
INVER GROVE HEIGHTS MN
55077-5438
US

IV. Provider business mailing address

10842 ALAMEDA AVE
INVER GROVE HEIGHTS MN
55077-5438
US

V. Phone/Fax

Practice location:
  • Phone: 651-485-7831
  • 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: