Individual provider · NPI-1

Kevin P Mikus, MD

Family Medicine · Charlotte, NC

NPI number1023097938
StatusActive
Last updated in NPPESNov 16, 2012

Details

NPI
1023097938
Entity type
Individual (NPI-1)
Name
Kevin P Mikus
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jan 10, 2006
Last updated
Nov 16, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine27952NCYes
173000000X Legal Medicine27952NC

Practice location

4525 Cameron Valley Pkwy Ste 3100
Charlotte, NC 28211-4377

Phone 704-302-8375 · Fax 704-302-9071

Mailing address

Po Box 601952
Charlotte, NC 28260-1952

Phone 704-302-8375 · Fax 704-302-8548

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