Provider Demographics
NPI:1497427611
Name:MIKAV, INC
Entity Type:Organization
Organization Name:MIKAV, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MILADINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VUCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-459-2324
Mailing Address - Street 1:739 ADDISON DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3441
Mailing Address - Country:US
Mailing Address - Phone:727-459-2324
Mailing Address - Fax:
Practice Address - Street 1:739 ADDISON DR NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3441
Practice Address - Country:US
Practice Address - Phone:727-459-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002052300Medicaid