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General NPI Number Information
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NPI Number | 1205463213
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Entity Type | Individual
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Provider Name | MINA MIKHAEL
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Gender | Male
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 111 EAST 210TH STREET
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City | BRONX
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State | NY
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Zip | 10467
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Country | US
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Telephone | 718-920-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE FL 2
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-2704
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0100769
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License Number State | MD
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