Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207NS0135X | Procedural Dermatology | ME0029781 | FL |
N | 2082S0105X | Plastic Hand Surgeon | ME0029781 | FL |
N | 208200000X | Surgeon | ME0029781 | FL |
N | 208600000X | Surgeon | ME0029781 | FL |
N | 2086S0120X | Pediatric Surgery | ME0029781 | FL |
N | 2086S0122X | Plastic and Reconstructive Surgery | ME0029781 | FL |
N | 2086S0127X | Trauma Surgeon | ME0029781 | FL |
NPI | 1275625006 |
---|---|
Provider Name | Mrs. Miloslava Souckova Mician |
First Address | Tampa, FL 33614 |
Second Address | Tampa, FL 33614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D67074 | (02) |