Individual
MR. LESLIE JOHN MITKOS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 449-0324
Mailing address
619 CASTINE WAY, WILMINGTON, NC 28412-2763
(217) 494-7415
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.002508
IL
Other
Enumeration date
07/11/2013
Last updated
03/21/2017
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