Individual
MS. SANDRA LYNN MIKULICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
17850 KEDZIE AVE STE 3250, HAZEL CREST, IL 60429-2082
(708) 799-8700
(708) 957-1830
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209007221
IL
363LF0000X
Family Nurse Practitioner
209007221
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3160176976
BLUE CROSS
IL
01
—
CM7411
RAILROAD MEDICARE
IL
01
—
P00694835
RAILROAD MEDICARE
IL
Enumeration date
09/08/2008
Last updated
03/06/2025
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