Basic Information
Provider Information
NPI: 1437336575
EntityType: 2
ReplacementNPI:  
OrganizationName: MIKA & MIKA PC
LastName:  
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Credential:  
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Mailing Information
Address1: 10415 GRAND RIVER RD
Address2: STE 100
City: BRIGHTON
State: MI
PostalCode: 481166533
CountryCode: US
TelephoneNumber: 8102271020
FaxNumber: 8102274930
Practice Location
Address1: 10415 GRAND RIVER RD
Address2: STE 100
City: BRIGHTON
State: MI
PostalCode: 481166533
CountryCode: US
TelephoneNumber: 8102271020
FaxNumber: 8102274930
Other Information
ProviderEnumerationDate: 01/30/2008
LastUpdateDate: 01/30/2008
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: MIKA
AuthorizedOfficialFirstName: DAVID
AuthorizedOfficialMiddleName: EDWIN
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 8102271020
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: D.O.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XDM007282MIY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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