Provider Demographics
NPI:1427229368
Name:MIKULEC, ELIZABETH MAE (RD)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MAE
Last Name:MIKULEC
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 YOSEMITE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1033
Mailing Address - Country:US
Mailing Address - Phone:248-393-4569
Mailing Address - Fax:
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1330
Practice Address - Country:US
Practice Address - Phone:248-355-3033
Practice Address - Fax:248-355-4936
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00698356133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered