Provider Demographics
NPI:1376782441
Name:JOHN P MIHALOVICH PHD PA
Entity Type:Organization
Organization Name:JOHN P MIHALOVICH PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MIHALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:772-370-9836
Mailing Address - Street 1:2850 SE CALVIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5808
Mailing Address - Country:US
Mailing Address - Phone:772-370-9836
Mailing Address - Fax:772-871-7822
Practice Address - Street 1:2850 SE CALVIN ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5808
Practice Address - Country:US
Practice Address - Phone:772-370-9836
Practice Address - Fax:772-871-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75297AMedicare UPIN