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General NPI Number Information
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NPI Number | 1982667697
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Entity Type | Individual
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Provider Name | SUSAN A MIKO DO
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 657 N TOWN CENTER DR
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City | LAS VEGAS
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State | NV
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Zip | 89144-6367
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Country | US
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Telephone | 702-233-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 MARBELLA RIDGE CT
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City | LAS VEGAS
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State | NV
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Zip | 89117-1488
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Country | US
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Telephone | 702-254-2720
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 1212
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License Number State | NV
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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 | 1212
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 1212
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License Number State | NV
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