Provider Demographics
NPI:1336254887
Name:MIKULEC, KATHARINE H (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:H
Last Name:MIKULEC
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Gender:F
Credentials:MD
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Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:SUITE 504
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:314-205-6633
Mailing Address - Fax:314-523-2798
Practice Address - Street 1:121 SAINT LUKES CENTER DR
Practice Address - Street 2:SUITE 504
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-205-6633
Practice Address - Fax:314-523-2798
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-11-02
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Provider Licenses
StateLicense IDTaxonomies
MO2004019693207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
841682728OtherTAX ID
MO1336254887OtherRR MEDICARE
MODP1487OtherRR MEDICARE
MO1306088182OtherRR MEDICARE
MOP00733645OtherRR MEDICARE
MODP1487OtherRR MEDICARE
MOP00733645OtherRR MEDICARE
H84975Medicare UPIN