Provider Demographics
NPI:1770566523
Name:MIKOS, STEPHEN E (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:MIKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1265 UPPER HEMBREE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1143
Mailing Address - Country:US
Mailing Address - Phone:770-442-1180
Mailing Address - Fax:770-442-5824
Practice Address - Street 1:1265 UPPER HEMBREE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1143
Practice Address - Country:US
Practice Address - Phone:770-442-1180
Practice Address - Fax:770-442-5824
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2009-12-09
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Provider Licenses
StateLicense IDTaxonomies
GA034201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDDVSMedicare ID - Type Unspecified
GAF08962Medicare UPIN