MEDICARE: DR. PAUL M. MIKUS II 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	207R00000X	Internal Medicine Physician	ME98180	FL
2	208000000X	Pediatrics Physician	ME98180	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00451227	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1356363196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL M. MIKUS II M.D.

Provider Business Mailing Address
First Line	:	PO BOX 743409
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3409
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:	727-532-1325

Provider Business Practice Location Address
First Line	:	8787 BRYAN DAIRY RD
Second Line	:	SUITE 275
City	:	LARGO
State	:	FL
Zip	:	33777-1260
Country	:	US
Telephone Number	:	727-394-5650
Fax Number	:	813-635-7939

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/05/2016

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