Individual
ELENI MARIE MIJALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-3037
Mailing address
802 LAKELAND DR APT 364, JACKSON, MS 39216-4627
(318) 286-9770
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
T-4423
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
04/04/2021
Last updated
09/09/2021
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