Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DT-2054 | HI |
N | 1223G0001X | General Practice | DT-2054 | HI |
N | 213EG0000X | General Practice | DT-2054 | HI |
NPI | 1073698544 |
---|---|
Provider Name | Dr. Randall W Mikulik |
First Address | Kailua, HI 96734-3667 |
Second Address | Honolulu, HI 96814-1879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00992101 | (05) | HI |
2054 | HAWAII DENTAL SERVICE (01) | HI |
241943 | HMSA (01) | HI |