Provider Demographics
NPI:1013969393
Name:MIKOLA, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MIKOLA
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:STSE 306
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-1777
Practice Address - Fax:843-884-0710
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC16144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC161443Medicaid
SC571020809012OtherBCBS
SCP00102686OtherRR MEDICARE
SCP00834833OtherRAILROAD MEDICARE ID-RSFPN
SC571020809058OtherTRICARE
SC571020809012OtherBCBS
SCF86172Medicare UPIN
SC161443Medicaid
SCF861724959Medicare PIN
SCF861726795Medicare PIN
SCF861729223Medicare PIN