Provider Demographics
NPI:1336989334
Name:HONOMICHL, MIKOLAS CARL
Entity type:Individual
Prefix:
First Name:MIKOLAS
Middle Name:CARL
Last Name:HONOMICHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MIK
Other - Middle Name:CARL
Other - Last Name:HONOMICHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9837 POST OAK DR
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018-9307
Mailing Address - Country:US
Mailing Address - Phone:913-293-7006
Mailing Address - Fax:
Practice Address - Street 1:1105 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3739
Practice Address - Country:US
Practice Address - Phone:913-293-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer