Provider Demographics
NPI:1528295722
Name:KAREN C. MIKUS, PHD, PC
Entity type:Organization
Organization Name:KAREN C. MIKUS, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-761-7247
Mailing Address - Street 1:1945 PAULINE BLVD
Mailing Address - Street 2:SUITE 21-B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5047
Mailing Address - Country:US
Mailing Address - Phone:734-761-7247
Mailing Address - Fax:
Practice Address - Street 1:1945 PAULINE BLVD
Practice Address - Street 2:SUITE 21-B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5047
Practice Address - Country:US
Practice Address - Phone:734-761-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68-0-H1-1474-0OtherBLUE CROSS BLUE SHIELD PIN