Provider Demographics
NPI:1477797538
Name:MCDOUGALL, MIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKA
Middle Name:
Last Name:MCDOUGALL
Suffix:
Gender:F
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 14039
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-6039
Mailing Address - Country:US
Mailing Address - Phone:707-538-8609
Mailing Address - Fax:
Practice Address - Street 1:2777 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4795
Practice Address - Country:US
Practice Address - Phone:707-538-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR160655207Q00000X
CA124894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine