Individual
MELISSA MIKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
58 ROY BEALL DR, LUVERNE, AL 36049-6800
(334) 335-1212
Mailing address
5303 VAUGHN RD, MONTGOMERY, AL 36116-1120
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.776
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.776
LICENSE
AL
Enumeration date
09/30/2011
Last updated
12/05/2011
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