Individual
CHRISTINA MARIE MIMIKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1250 FOREST AVE STE 301, PORTLAND, ME 04103
(207) 797-5753
Mailing address
1250 FOREST AVE STE 301, PORTLAND, ME 04103-1884
(207) 797-5753
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
2016017553
MO
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
5101018354
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AR
05
—
PENDING
—
MO
Enumeration date
07/09/2009
Last updated
10/19/2018
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