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General NPI Number Information
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NPI Number | 1437312774
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Entity Type | Individual
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Provider Name | DAVID KING MIKOLYZK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 1650 S 41ST ST
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City | MANITOWOC
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State | WI
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Zip | 54220-7316
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Country | US
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Telephone | 920-320-5251
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Fax | 920-682-2006
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Provider Business Mailing Address
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Address Line | PO BOX 22487
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City | GREEN BAY
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State | WI
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Zip | 54305-2487
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Country | US
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Telephone | 920-445-7222
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Fax | 920-445-7238
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036117670
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 53986
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License Number State | WI
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