Provider Demographics
NPI:1215102421
Name:MIKOLICH, BRANDON MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:MIKOLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2999 PRESIDENTIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3689
Mailing Address - Country:US
Mailing Address - Phone:724-983-1800
Mailing Address - Fax:724-983-8252
Practice Address - Street 1:2999 PRESIDENTIAL BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3689
Practice Address - Country:US
Practice Address - Phone:724-983-1800
Practice Address - Fax:724-983-8252
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT180665207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease