Provider Demographics
NPI:1023053220
Name:MIKOWSKI, STANLEY MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:MICHAEL
Last Name:MIKOWSKI
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 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:1511 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6505
Practice Address - Country:US
Practice Address - Phone:352-867-8311
Practice Address - Fax:352-867-1053
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6211207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255949800Medicaid
FL80582OtherBCBS FL
FL80582VMedicare PIN
FLP00072783Medicare PIN
FL80582WMedicare PIN
FL80582XMedicare PIN
FLF17379Medicare UPIN
FL80582TMedicare PIN
FL255949800Medicaid
FL050075235Medicare PIN
FL80582OtherBCBS FL
FL80582UMedicare PIN