Provider Demographics
NPI:1306845672
Name:MIKICH, YELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:MIKICH
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 1:3550 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1088
Mailing Address - Country:US
Mailing Address - Phone:413-781-8290
Mailing Address - Fax:413-732-7628
Practice Address - Street 1:3550 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1088
Practice Address - Country:US
Practice Address - Phone:413-781-8290
Practice Address - Fax:413-737-8540
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154223207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3170772Medicaid
MA875845OtherUS HEALTHCARE
MA0011041OtherNEIGHBORHOOD HEALTH
MA154223OtherTUFTS
MA07-40454OtherUNITED HEALTHCARE
MA000006125OtherBMC HEALTHNET
MA130833OtherPILGRIM
MA154223OtherCONNECTICARE
MA20583OtherHEALTH NEW ENGLAND
MA160036619OtherRR MEDICARE
MAMIJ18169OtherBLUE SHIELD OF MASS
MAMIA22755Medicare PIN
MA000006125OtherBMC HEALTHNET
MA154223OtherTUFTS