Provider Demographics
NPI:1588840953
Name:PAUL A. MIKEL MD PLC
Entity Type:Organization
Organization Name:PAUL A. MIKEL MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MIKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-668-4411
Mailing Address - Street 1:3921 E BASELINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2727
Mailing Address - Country:US
Mailing Address - Phone:480-668-4411
Mailing Address - Fax:480-776-5169
Practice Address - Street 1:3921 E BASELINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2727
Practice Address - Country:US
Practice Address - Phone:480-668-4411
Practice Address - Fax:480-776-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21229207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ163791Medicaid
AZZ61999Medicare PIN
AZ163791Medicaid