Individual
GREGORY DAVID MIKUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
12361 W BOLA DR STE 100, SURPRISE, AZ 85378-9021
(602) 641-9486
(480) 500-8430
Mailing address
12361 W BOLA DR STE 100, SURPRISE, AZ 85378-9021
(602) 641-9486
(480) 500-8430
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN169267
AZ
Other
Enumeration date
05/01/2019
Last updated
10/21/2020
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