Individual
DR. HARITHA MIKKILINENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
651 W MARION RD, MOUNT GILEAD, OH 43338-1027
(419) 946-5015
(937) 619-4150
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD2020-0327
NM
207P00000X
Emergency Medicine Physician
N5245
TX
207R00000X
Internal Medicine Physician
Primary
N5245
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000719102
BCBS
KY
05
—
7100066060
—
KY
01
—
P00955671
RR MEDICARE
KY
Enumeration date
10/15/2008
Last updated
09/13/2023
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