Provider Demographics
NPI:1508563990
Name:MIKA MEDICAL CORP
Entity Type:Organization
Organization Name:MIKA MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:MAGIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-678-0232
Mailing Address - Street 1:PASEO LOS CORALES I
Mailing Address - Street 2:564 CALLE GOLFO DE MEXICO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-678-0232
Mailing Address - Fax:787-654-7444
Practice Address - Street 1:BO ALMIRANTE NORTE
Practice Address - Street 2:CARR 160 KM 4.5
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-654-8465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty