Provider Demographics
NPI:1831423359
Name:JUDITH A MIKACICH MD INC
Entity type:Organization
Organization Name:JUDITH A MIKACICH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIKACICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-927-3178
Mailing Address - Street 1:2277 FAIR OAKS BLVD
Mailing Address - Street 2:355
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5533
Mailing Address - Country:US
Mailing Address - Phone:916-927-3178
Mailing Address - Fax:916-927-1488
Practice Address - Street 1:2277 FAIR OAKS BLVD
Practice Address - Street 2:355
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5500
Practice Address - Country:US
Practice Address - Phone:916-927-3178
Practice Address - Fax:916-927-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty