Individual
GREGORY JAMES MICKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(815) 814-7501
Mailing address
1611 NW 12TH AVE, MIAMI, FL 33136-1096
(305) 585-1111
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME121261
FL
Other
Enumeration date
04/25/2013
Last updated
11/16/2018
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