Provider Demographics
NPI:1356454102
Name:MIKUL, LARRY S (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:MIKUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25420 US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:JEMISON
Mailing Address - State:AL
Mailing Address - Zip Code:35085-7868
Mailing Address - Country:US
Mailing Address - Phone:205-668-1616
Mailing Address - Fax:205-668-1038
Practice Address - Street 1:25420 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:JEMISON
Practice Address - State:AL
Practice Address - Zip Code:35085-7868
Practice Address - Country:US
Practice Address - Phone:205-668-1616
Practice Address - Fax:205-668-1038
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000038926Medicaid
AL38926Medicare ID - Type Unspecified
AL000038926Medicaid