Provider Demographics
NPI:1013110154
Name:EHIMIKA, MIKSON
Entity Type:Individual
Prefix:
First Name:MIKSON
Middle Name:
Last Name:EHIMIKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8728
Mailing Address - Country:US
Mailing Address - Phone:956-412-0700
Mailing Address - Fax:
Practice Address - Street 1:1806 PHEASANT DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8728
Practice Address - Country:US
Practice Address - Phone:956-412-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health