Individual
DR. MARIA MIKOLAENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2979 MAIN ST, BRIDGEPORT, CT 06606-4284
(203) 382-2345
(203) 366-0868
Mailing address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
66720
CT
207QA0505X
Adult Medicine Physician
OS15147
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS15147
STATE LICENSE
FL
Enumeration date
05/29/2014
Last updated
10/02/2020
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