Provider Demographics
NPI:1275625006
Name:MICIAN, MILOSLAVA SOUCKOVA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MILOSLAVA
Middle Name:SOUCKOVA
Last Name:MICIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MILA
Other - Middle Name:
Other - Last Name:MICIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3619 W WATERS AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-932-8866
Mailing Address - Fax:813-932-9668
Practice Address - Street 1:3619 W WATERS AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-932-8866
Practice Address - Fax:813-932-9668
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0029781207NS0135X, 2082S0105X, 208600000X, 2086S0120X, 2086S0122X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Not Answered2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Not Answered2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
04238Medicare ID - Type Unspecified
D67074Medicare UPIN