Provider Demographics
NPI:1508839614
Name:MIKULA, JUSTIN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:PAUL
Last Name:MIKULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1615 N RIVER RD NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2437
Mailing Address - Country:US
Mailing Address - Phone:330-372-2333
Mailing Address - Fax:330-373-1111
Practice Address - Street 1:1615 N RIVER RD NE
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2437
Practice Address - Country:US
Practice Address - Phone:330-372-2333
Practice Address - Fax:330-373-1111
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.084818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2580434Medicaid
I44593Medicare UPIN
OH2580434Medicaid