Provider Demographics
NPI:1770518144
Name:MIKESH, CAREN F (MD)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:F
Last Name:MIKESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5523
Mailing Address - Country:US
Mailing Address - Phone:239-775-3535
Mailing Address - Fax:239-775-3636
Practice Address - Street 1:694 8TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5523
Practice Address - Country:US
Practice Address - Phone:239-775-3535
Practice Address - Fax:239-775-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL202948994207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81413OtherBCBS
H91696Medicare UPIN
U1138AMedicare ID - Type Unspecified