Basic Information
| Provider Information | |||||||||
| NPI: | 1649402181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIKEL | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | CARLETTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 ALUMNI PARK PLAZA, SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592577910 | ||||||||
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| Practice Location | |||||||||
| Address1: | 740 S LIMESTONE ST STE B317 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592573390 | ||||||||
| FaxNumber: | 8592575989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 08/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 0360 | KY | Y | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 0859 | KY | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.