MEDICARE: MS. ANNA J MIKOS CNM

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	209.009030	IL
2	367A00000X	Advanced Practice Midwife	209.009016	IL

General Provider Information

NPI Number	:	1487936415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA J MIKOS CNM

Provider Business Mailing Address
First Line	:	4700 W 95TH ST STE 303
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2572
Country	:	US
Telephone Number	:	773-319-7341
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 W 95TH ST STE 303
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2572
Country	:	US
Telephone Number	:	708-857-7230
Fax Number	:	708-425-5779

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	12/29/2021

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