Provider Demographics
NPI:1649488347
Name:MIKLAVCIC, AMIE YVETTE (MD, MMS)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:YVETTE
Last Name:MIKLAVCIC
Suffix:
Gender:F
Credentials:MD, MMS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:7515 RIGHT FLANK ROAD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3818
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-559-2046
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101246127207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649488347Medicaid
VAVAA113158Medicare PIN