Provider Demographics
NPI:1457596074
Name:MIKUS, RAYMOND BERNARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BERNARD
Last Name:MIKUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:BERNARD
Other - Last Name:MIKUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2404 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34695
Mailing Address - Country:US
Mailing Address - Phone:727-945-0100
Mailing Address - Fax:727-945-0133
Practice Address - Street 1:2404 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3943
Practice Address - Country:US
Practice Address - Phone:727-945-0100
Practice Address - Fax:727-945-0133
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine