Individual
DR. BRIAN MIKOLASKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD MBA MS
Contact information
Practice address
2109 HARTFORD AVE, JOHNSTON, RI 02919-3246
(626) 319-5932
(626) 380-2395
Mailing address
2109 HARTFORD AVE, JOHNSTON, RI 02919-3246
(626) 319-5932
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
149352
CA
207R00000X
Internal Medicine Physician
Primary
16379
RI
207R00000X
Internal Medicine Physician
276683
MA
207R00000X
Internal Medicine Physician
463951
PA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
16379
RI
282N00000X
General Acute Care Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A149352
THE MEDICAL BOARD OF CALIFORNIA
CA
01
—
MD463951
PENNSYLVANIA STATE BOARD OF MEDICINE
PA
Enumeration date
04/15/2014
Last updated
08/14/2025
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