Provider Demographics
NPI:1275053712
Name:MIKROS, ATHENA (MD)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:MIKROS
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:PSC 475 BOX 1375
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350-1375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USNH YOKOSUKA
Practice Address - Street 2:INAOKACHO, 82
Practice Address - City:YOKOSUKA
Practice Address - State:KANAGAWA
Practice Address - Zip Code:2380001
Practice Address - Country:JP
Practice Address - Phone:046-816-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-0311207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine