Provider Demographics
NPI:1083189724
Name:MI CLINICA LLC
Entity Type:Organization
Organization Name:MI CLINICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BIJAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-270-3823
Mailing Address - Street 1:2119 RIVERWALK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2700
Mailing Address - Country:US
Mailing Address - Phone:405-482-8221
Mailing Address - Fax:405-421-9640
Practice Address - Street 1:4200 S MAY AVE STE D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-3200
Practice Address - Country:US
Practice Address - Phone:405-482-8221
Practice Address - Fax:405-421-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty