Provider Demographics
NPI:1316139785
Name:EUGENE MIKNOWSKI M.D., P.C.
Entity type:Organization
Organization Name:EUGENE MIKNOWSKI M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-296-4002
Mailing Address - Street 1:1145 19TH ST NW STE 504
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3715
Mailing Address - Country:US
Mailing Address - Phone:202-296-4002
Mailing Address - Fax:202-331-9365
Practice Address - Street 1:1145 19TH ST NW STE 504
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3715
Practice Address - Country:US
Practice Address - Phone:202-296-4002
Practice Address - Fax:202-331-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC16016207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95112Medicare UPIN
DC480987Medicare PIN