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General NPI Number Information
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NPI Number | 1346669512
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Entity Type | Individual
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Provider Name | BRIAN MIKOLASKO MD MBA MS
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 2109 HARTFORD AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-3246
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Country | US
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Telephone | 626-319-5932
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Fax | 626-380-2395
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Provider Business Mailing Address
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Address Line | 2109 HARTFORD AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-3246
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Country | US
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Telephone | 626-319-5932
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 463951
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 149352
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 276683
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 16379
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License Number State | RI
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Taxonomy #5
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16379
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License Number State | RI
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