MEDICARE: DR. JAMES FRANK MIKULA DDS

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	122300000X	Dentist	30-012812	OH

General Provider Information

NPI Number	:	1790964823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES FRANK MIKULA DDS

Provider Business Mailing Address
First Line	:	13425 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4608
Country	:	US
Telephone Number	:	216-226-2344
Fax Number	:	216-529-2217

Provider Business Practice Location Address
First Line	:	13425 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4608
Country	:	US
Telephone Number	:	216-226-2344
Fax Number	:	216-529-2217

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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