Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2008015977 | MO |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 02004241A | IN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 125062400 | IL |
NPI | 1144475666 |
---|---|
Provider Name | Jill Marie Mikles |
First Address | Seymour, IN 47274-2363 |
Second Address | Seymour, IN 47274-2363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2008 |
Last Update Date | 23/07/2014 |