MEDICARE: DR. STEFANIE ANN MIKULICS M.D.

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	207VG0400X	Gynecology Physician	A68329	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A683290	OTHER	CA	BLUE SHIELD PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275553497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFANIE ANN MIKULICS M.D.

Provider Business Mailing Address
First Line	:	1050 LAS TABLAS RD
Second Line	:	SUITE 2
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9729
Country	:	US
Telephone Number	:	805-434-9441
Fax Number	:	805-434-9456

Provider Business Practice Location Address
First Line	:	1050 LAS TABLAS RD
Second Line	:	SUITE 2
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9729
Country	:	US
Telephone Number	:	805-434-9441
Fax Number	:	805-434-9456

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/14/2008

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