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General NPI Number Information
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NPI Number | 1023097938
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Entity Type | Individual
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Provider Name | KEVIN P MIKUS MD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 4525 CAMERON VALLEY PKWY STE 3100
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City | CHARLOTTE
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State | NC
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Zip | 28211-4377
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Country | US
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Telephone | 704-302-8375
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Fax | 704-302-9071
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Provider Business Mailing Address
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Address Line | PO BOX 601952
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City | CHARLOTTE
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State | NC
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Zip | 28260-1952
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Country | US
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Telephone | 704-302-8375
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Fax | 704-302-8548
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 27952
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27952
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License Number State | NC
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