Provider Demographics
NPI:1679722714
Name:MICKLAS, ROBERT (PA-C, MMS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MICKLAS
Suffix:
Gender:M
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 NW 72ND AVE
Mailing Address - Street 2:(SUITE 101)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1349
Mailing Address - Country:US
Mailing Address - Phone:305-599-9933
Mailing Address - Fax:
Practice Address - Street 1:3399 NW 72ND AVE
Practice Address - Street 2:(SUITE 101)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1349
Practice Address - Country:US
Practice Address - Phone:305-599-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant