Provider Demographics
NPI:1639141880
Name:MIKES, BEVERLY A (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:MIKES
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 1:11 RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6954
Mailing Address - Country:US
Mailing Address - Phone:856-802-0732
Mailing Address - Fax:
Practice Address - Street 1:1930 STATE HWY 70 E
Practice Address - Street 2:STE S-93
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-424-8091
Practice Address - Fax:856-424-0704
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060897207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050902Medicare PIN