Provider Demographics
NPI:1740241959
Name:MIKUS, JOSEPH L (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:MIKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 LINDEN DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-722-7282
Mailing Address - Fax:540-722-5060
Practice Address - Street 1:142 LINDEN DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-722-7282
Practice Address - Fax:540-722-5060
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052335207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010148979Medicaid
F37457Medicare UPIN
VA010148979Medicaid