MEDICARE: MARY JANE MIKULS 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	208000000X	Pediatrics Physician	17882	NE

General Provider Information

NPI Number	:	1447361449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE MIKULS M.D.

Provider Business Mailing Address
First Line	:	8401 W DODGE RD
Second Line	:	SUITE 280
City	:	OMAHA
State	:	NE
Zip	:	68114-3451
Country	:	US
Telephone Number	:	402-955-6877
Fax Number	:	402-955-6880

Provider Business Practice Location Address
First Line	:	110 N 175TH ST
Second Line	:	SUITE 1000
City	:	OMAHA
State	:	NE
Zip	:	68118-3582
Country	:	US
Telephone Number	:	402-955-5437
Fax Number	:	402-955-7310

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/23/2013

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