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NPI Code Detail

MEDICARE: SUSAN A MIKO DO

MEDICARE: SUSAN A MIKO DO
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
1207P00000XEmergency Medicine Physician1212NV
2207R00000XInternal Medicine Physician1212NV
3208000000XPediatrics Physician1212NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2AZ0201750OTHERAZAZ BC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982667697
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN A MIKO DO
Provider Business Mailing Address
First Line : 1500 MARBELLA RIDGE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-1488
Country : US
Telephone Number : 702-254-2720
Fax Number :
Provider Business Practice Location Address
First Line : 657 N TOWN CENTER DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6367
Country : US
Telephone Number : 702-233-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 01/20/2010

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Directions to “ SUSAN A MIKO DO” Practice Location

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