Provider Demographics
NPI:1811910425
Name:MIKA, PHILIP JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:MIKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2125 RIVER RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1135
Mailing Address - Country:US
Mailing Address - Phone:518-382-8350
Mailing Address - Fax:518-382-0345
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-382-8350
Practice Address - Fax:518-382-0345
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY115728207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070119000062OtherFIDELIS - ENDOCRINOLOGY
NY4625730OtherAETNA
NY47346OtherGHI/HMO
NY28N081OtherEMPIRE BC
NY200097OtherSENIOR WHOLE HEALTH
NY000408519001OtherBSNENY
NY11120OtherMVP
NY28102OtherMVP
NY00527477Medicaid
NY041208000020OtherFIDELIS - INT MEDICINE
NY10001371OtherCDPHP
NY56823RMedicare ID - Type UnspecifiedMEDICARE
NY00527477Medicaid