Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 200400553 | NC |
N | 207XS0117X | Orthopaedic Spine Surgeon | 200400553 | NC |
NPI | 1316940133 |
---|---|
Provider Name | Mark R Mikles |
First Address | Raleigh, NC 27612-5243 |
Second Address | Raleigh, NC 27612-5243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12421 | (02) |