Provider Demographics
NPI:1245294065
Name:GEORGE J MIKOS MD LLC
Entity type:Organization
Organization Name:GEORGE J MIKOS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-4919
Mailing Address - Street 1:2301 RIVER RD
Mailing Address - Street 2:#300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206
Mailing Address - Country:US
Mailing Address - Phone:502-814-3175
Mailing Address - Fax:502-426-5493
Practice Address - Street 1:3950 KRESGE WAY
Practice Address - Street 2:STE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-897-2667
Practice Address - Fax:502-895-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9842Medicare ID - Type Unspecified