Individual
DR. MARIANO B MIKULIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1824 KING STREET, SUITE 300, JACKSONVILLE, FL 32204-4736
(904) 388-1820
(904) 388-1827
Mailing address
1824 KING STREET, SUITE 300, JACKSONVILLE, FL 32204-4736
(904) 388-1820
(904) 388-1827
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
046312
GA
207RC0000X
Cardiovascular Disease Physician
Primary
ME73598
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00793581A
—
GA
05
—
00793581D
—
GA
01
—
2049932
AETNA
FL
01
—
245320
AVMED
FL
05
—
254507100
—
FL
01
—
365273
BCBS
GA
01
—
42895
BCBS
FL
Enumeration date
05/23/2005
Last updated
05/28/2014
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