Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 18949 | SC |
NPI | 1003889304 |
---|---|
Provider Name | Edward J Mikol |
First Address | Pawleys Island, SC 29585-8746 |
Second Address | Murrells Inlet, SC 29576-5113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 09/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G02631 | (02) | SC |
GP3856 | (05) | SC |