MEDICARE: DR. ROBERT C MIKLOS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	016003168	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275538811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT C MIKLOS DPM

Provider Business Mailing Address
First Line	:	6634 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2408
Country	:	US
Telephone Number	:	773-586-5487
Fax Number	:	773-586-9523

Provider Business Practice Location Address
First Line	:	6634 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2408
Country	:	US
Telephone Number	:	773-586-5487
Fax Number	:	773-586-9523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	01/17/2013

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