MEDICARE: ROBERT W MIKISKA PA-C

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	363A00000X	Physician Assistant	PA10003227	WA
2	207P00000X	Emergency Medicine Physician	PA10003227	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1659383842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT W MIKISKA PA-C

Provider Business Mailing Address
First Line	:	1550 S PIONEER WAY STE 100
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-4637
Country	:	US
Telephone Number	:	509-793-9790
Fax Number	:	509-764-3255

Provider Business Practice Location Address
First Line	:	1550 S PIONEER WAY STE 100
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-4637
Country	:	US
Telephone Number	:	509-793-9790
Fax Number	:	509-764-3255

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	06/18/2021

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Directions to “ ROBERT W MIKISKA PA-C” Practice Location

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