Provider Demographics
NPI:1720373400
Name:MISKA, PAUL ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:MISKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3870
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3870
Mailing Address - Country:US
Mailing Address - Phone:801-662-3578
Mailing Address - Fax:801-662-3583
Practice Address - Street 1:100 N MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-3578
Practice Address - Fax:801-662-3583
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-9232207L00000X
WI64180207L00000X, 207LP3000X
ORDO176139207L00000X
UT11234377-1204207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology