Individual
KEVIN KAYE MIKAELIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2545 W HAMMER LN, STOCKTON, CA 95209-2839
(209) 957-7050
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G78209
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0219850005
CIGNA MEDICARE PIN
CA
Enumeration date
07/01/2005
Last updated
10/28/2010
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