Basic Information
| Provider Information | |||||||||
| NPI: | 1801907605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIKO | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1326 PAPERMILL POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656735000 | ||||||||
| FaxNumber: | 8655885711 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 PIN HOOK RD | ||||||||
| Address2: | |||||||||
| City: | SPRING CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373814703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233650786 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000395 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 1469 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.