Christina Marie Mimikos
Otolaryngology/Facial Plastic Surgery
1250 Forest Ave Ste 301
Portland
, Maine 04103
Christina Marie Mimikos
Otolaryngology/Facial Plastic Surgery
1250 Forest Ave Ste 301
Portland
, Maine 04103
(207) 797-5753
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About
Features
Specialties
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Christina Marie Mimikos
- 1250 Forest Ave Ste 301
- Portland, ME
- Zip : 04103-1884
- Phone : (207) 797-5753
Second Address
- Christina Marie Mimikos
- 1250 Forest Ave Ste 301
- Portland, ME
- Zip : 04103
- Phone : (207) 797-5753
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2016017553 | MO |
| N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101018354 | MI |
National Provider Identifier
| NPI | 1093944258 |
|---|---|
| Provider Name | Christina Marie Mimikos |
| First Address | Portland, ME 04103-1884 |
| Second Address | Portland, ME 04103 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/07/2009 |
| Last Update Date | 19/10/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| PENDING | (05) | AR |
| PENDING | (05) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.