Healthcare Provider Details

I. General information

NPI: 1740241959
Provider Name (Legal Business Name): JOSEPH L MIKUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 LINDEN DRIVE SUITE 106
WINCHESTER VA
22601
US

IV. Provider business mailing address

142 LINDEN DRIVE SUITE 106
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-7282
  • Fax: 540-722-5060
Mailing address:
  • Phone: 540-722-7282
  • Fax: 540-722-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101052335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: