Individual
THEODORE MIKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4391 FALLOWFIELD LN SW, LILBURN, GA 30047-7405
(678) 380-4081
(678) 380-4348
Mailing address
4391 FALLOWFIELD LN SW, LILBURN, GA 30047-7405
(678) 380-4081
(678) 380-4348
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
044966
GA
Other
Enumeration date
08/25/2006
Last updated
07/08/2007
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