=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770518144
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAREN F MIKESH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 03/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 694 8TH ST N
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-775-3535
-----------------------------------------------------
Fax | 239-775-3636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 694 8TH ST N
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-775-3535
-----------------------------------------------------
Fax | 239-775-3636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207NS0135X
-----------------------------------------------------
Taxonomy Name | Procedural Dermatology Physician
-----------------------------------------------------
License Number | 202948994
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------