MEDICARE: ALLISON ANN MIRIKE P.A.

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	PA02831	TX

General Provider Information

NPI Number	:	1780621151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON ANN MIRIKE P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1962
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76202-1962
Country	:	US
Telephone Number	:	940-503-3601
Fax Number	:	940-503-3602

Provider Business Practice Location Address
First Line	:	209 N BONNIE BRAE ST
Second Line	:	SUITE 304
City	:	DENTON
State	:	TX
Zip	:	76201-3708
Country	:	US
Telephone Number	:	940-503-3601
Fax Number	:	940-503-3602

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/30/2017

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Directions to “ ALLISON ANN MIRIKE P.A.” Practice Location

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