Provider Demographics
NPI:1104569219
Name:SPIRES, MIKAYLA LAUREN (DO)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:LAUREN
Last Name:SPIRES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:LAUREN
Other - Last Name:PETESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR.
Mailing Address - Street 2:DC 029.10
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212
Mailing Address - Country:US
Mailing Address - Phone:573-884-3233
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR.
Practice Address - Street 2:DC 029.10
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212
Practice Address - Country:US
Practice Address - Phone:573-884-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2023022504207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program