Individual
KEVIN P MIKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4525 CAMERON VALLEY PKWY STE 3100, CHARLOTTE, NC 28211-4377
(704) 302-8375
(704) 302-9071
Mailing address
PO BOX 601952, CHARLOTTE, NC 28260-1952
(704) 302-8375
(704) 302-8548
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
27952
NC
207Q00000X
Family Medicine Physician
Primary
27952
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8958796
—
NC
01
—
CN8132
MEDICARE RAILROAD
NC
Enumeration date
01/10/2006
Last updated
11/16/2012
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