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1639172836

NPI Code Detail

MEDICARE: DR. MARIANO B MIKULIC MD

MEDICARE: DR. MARIANO B MIKULIC MD

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	207RC0000X	Cardiovascular Disease Physician	ME73598	FL
2	207RC0000X	Cardiovascular Disease Physician	046312	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	365273	OTHER	GA	BCBS
2	245320	OTHER	FL	AVMED
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	42895	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2049932	OTHER	FL	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639172836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANO B MIKULIC MD

Provider Business Mailing Address
First Line	:	1824 KING STREET
Second Line	:	SUITE 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4736
Country	:	US
Telephone Number	:	904-388-1820
Fax Number	:	904-388-1827

Provider Business Practice Location Address
First Line	:	1824 KING STREET
Second Line	:	SUITE 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4736
Country	:	US
Telephone Number	:	904-388-1820
Fax Number	:	904-388-1827

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/28/2014

Similar Medicare Providers

1588667638 — DR. WILLIAM C PILCHER MD
Practice Location Address:

1824 KING STREET , SUITE 300
JACKSONVILLE, FL
32204-4736

Practice Phone: 904-388-1820
Practice Fax: 904-388-1827

1306849583 — DR. GEORGE S PILCHER MD
Practice Location Address:

1824 KING STREET , SUITE 300
JACKSONVILLE, FL
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Practice Phone: 904-388-1820
Practice Fax: 904-388-1827

1437152600 — DR. JAMES TIMOTHY WALSH MD
Practice Location Address:

1824 KING STREET , SUITE 300
JACKSONVILLE, FL
32204-4736

Practice Phone: 904-388-1820
Practice Fax: 904-388-1827

1225031438 — DR. CARLOS E ALOSILLA MD
Practice Location Address:

1824 KING STREET , SUITE 300
JACKSONVILLE, FL
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Practice Phone: 904-388-1820
Practice Fax: 904-388-1827

1881697084 — DR. STEVEN S NAUMAN MD
Practice Location Address:

1824 KING ST , SUITE 300
JACKSONVILLE, FL
32204-4736

Practice Phone: 904-388-1820
Practice Fax: 904-388-1827

1407858749 — RAYMOND LEE MD
Practice Location Address:

1824 KING ST STE 200
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Practice Phone: 904-384-3343
Practice Fax: 904-400-6671

Directions to “ DR. MARIANO B MIKULIC MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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