Individual
GREGORY J. MICKUNAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5201
(740) 446-5761
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5201
(740) 446-5761
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
21326
WV
207P00000X
Emergency Medicine Physician
Primary
35.076915
OH
207P00000X
Emergency Medicine Physician
H09359
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185284
UNISON MEDICAID #
OH
01
—
000000205913
ANTHEM BCBS
—
01
—
001714125
MOUNTAIN STATE BCBS
—
05
—
2183131
—
OH
05
—
3002989000
—
WV
01
—
310917085143
OHIO MEDICAID CARESOURCE
OH
01
—
930106929
RR MEDICARE
—
Enumeration date
06/02/2006
Last updated
02/26/2024
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