Individual
DR. JEROME JOSEPH MIKLOUCICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
276-280 ROBINSON ST, BINGHAMTON, NY 13904-1659
(607) 722-2769
Mailing address
276-280 ROBINSON ST, BINGHAMTON, NY 13904-1659
(607) 722-2769
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
252865
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03113559
—
NY
Enumeration date
03/12/2007
Last updated
07/17/2009
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