Provider Demographics
NPI:1245547108
Name:MIKE, JOHN MARON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARON
Last Name:MIKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15896 DOUBLE EAGLE TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-9554
Mailing Address - Country:US
Mailing Address - Phone:561-714-2294
Mailing Address - Fax:561-499-1672
Practice Address - Street 1:96 SW ALLAPATTAH RD
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-4307
Practice Address - Country:US
Practice Address - Phone:772-597-9403
Practice Address - Fax:561-443-3829
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME00609012084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry