Provider Demographics
NPI:1215191770
Name:MIKKILINENI, HIMA (MD)
Entity Type:Individual
Prefix:
First Name:HIMA
Middle Name:
Last Name:MIKKILINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 SW 20TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7734
Mailing Address - Country:US
Mailing Address - Phone:352-622-4251
Mailing Address - Fax:352-622-0102
Practice Address - Street 1:2111 SW 20TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7734
Practice Address - Country:US
Practice Address - Phone:352-622-4251
Practice Address - Fax:352-622-0102
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105449207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009088100Medicaid
FLCP493ZOtherMEDICARE