Provider Demographics
NPI:1710177183
Name:MIKLIC, MARGARET S (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:S
Last Name:MIKLIC
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 1:3686 GRANDVIEW PARKWAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-971-5499
Mailing Address - Fax:205-971-5438
Practice Address - Street 1:3686 GRANDVIEW PARKWAY
Practice Address - Street 2:SUITE 320
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-971-5499
Practice Address - Fax:205-971-5438
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201431207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06070214Medicaid
LA1091448Medicaid
LA4M159Medicare PIN
LA1091448Medicaid