MEDICARE: DR. DAVID MIKLOS D.P.M.

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	135000715	IL

General Provider Information

NPI Number	:	1609146984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MIKLOS D.P.M.

Provider Business Mailing Address
First Line	:	6634 W ARCHER AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638
Country	:	US
Telephone Number	:	708-945-5649
Fax Number	:

Provider Business Practice Location Address
First Line	:	6634 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2408
Country	:	US
Telephone Number	:	708-945-5649
Fax Number	:

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

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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