Provider Demographics
NPI:1396842993
Name:MIKULICICH, ADRIAN GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:GEORGE
Last Name:MIKULICICH
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067
Mailing Address - Country:US
Mailing Address - Phone:858-756-4973
Mailing Address - Fax:858-756-2519
Practice Address - Street 1:5575 RUFFIN RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-277-2744
Practice Address - Fax:858-277-3085
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA216472085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22705Medicare UPIN
CAZZZ1900ZZMedicare ID - Type Unspecified