Provider Demographics
NPI:1336319045
Name:MILOSLAVA MICIAN MD PA
Entity Type:Organization
Organization Name:MILOSLAVA MICIAN MD PA
Other - Org Name:MILA MICIAN MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILOSLAVA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MICIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-932-8866
Mailing Address - Street 1:3619 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2783
Mailing Address - Country:US
Mailing Address - Phone:813-932-8866
Mailing Address - Fax:813-932-9668
Practice Address - Street 1:3619 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2783
Practice Address - Country:US
Practice Address - Phone:813-932-8866
Practice Address - Fax:813-932-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty