Provider Demographics
NPI:1437336575
Name:MIKA & MIKA PC
Entity Type:Organization
Organization Name:MIKA & MIKA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:MIKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-227-1020
Mailing Address - Street 1:10415 GRAND RIVER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6533
Mailing Address - Country:US
Mailing Address - Phone:810-227-1020
Mailing Address - Fax:810-227-4930
Practice Address - Street 1:10415 GRAND RIVER RD
Practice Address - Street 2:STE 100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6533
Practice Address - Country:US
Practice Address - Phone:810-227-1020
Practice Address - Fax:810-227-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM007282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty