Provider Demographics
NPI:1659347565
Name:MIKEL, PAUL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALAN
Last Name:MIKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ163791Medicaid
AZF56075Medicare UPIN
AZ62000Medicare ID - Type Unspecified