Individual
DR. MICHAEL S MIKULECKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2528 SISTER MARY COLUMBA DR, RED BLUFF, CA 96080-4327
(530) 528-6100
(530) 528-6196
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A90779
CA
Other
Enumeration date
11/14/2005
Last updated
07/21/2020
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