Provider Demographics
NPI:1689631822
Name:MIKLIN, JERRY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:S
Last Name:MIKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:500 ELDORADO BLVD
Mailing Address - Street 2:SUITE 6250
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0750
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:3655 LUTHERAN PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6018
Practice Address - Country:US
Practice Address - Phone:303-603-9800
Practice Address - Fax:303-403-6209
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO25248207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01252485Medicaid
COCOAAA0684Medicare PIN
CO68044Medicare ID - Type Unspecified
CO01252485Medicaid