Individual
DR. BOSE S. MIKKILINENI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D. FACS
Contact information
Practice address
419 CARRIAGE DR, BECKLEY, WV 25801-2805
(304) 253-8416
(866) 461-4726
Mailing address
419 CARRIAGE DR, BECKLEY, WV 25801-2805
(304) 253-8416
(866) 461-4726
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
12282
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720379
BCBS
WV
05
—
0128502000
—
WV
01
—
020002556
RAILROAD MEDICARE
WV
01
—
151389100
FEDERAL COMPENSATION #
WV
01
—
231835
MAMSI
WV
01
—
49236
ANTHEM BCBS
WV
01
—
550631859
TRICARE
WV
01
—
6441144
CIGNA
WV
01
—
68790
68790
WV
Enumeration date
09/05/2005
Last updated
06/04/2013
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