Basic Information
| Provider Information | |||||||||
| NPI: | 1487692349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIKOL | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 BELLE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441074202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165298446 | ||||||||
| FaxNumber: | 2165297048 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 BELLE AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441074202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165298446 | ||||||||
| FaxNumber: | 2165297048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 09/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35-05-1399-M | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0633229 | 05 | OH | MEDICAID |