Provider Demographics
NPI:1699547042
Name:MIKLIN, ZACHARY BENJAMIN (PA-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:BENJAMIN
Last Name:MIKLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 S GRAPE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2100
Mailing Address - Country:US
Mailing Address - Phone:303-728-4363
Mailing Address - Fax:
Practice Address - Street 1:500 E HAMPDEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2885
Practice Address - Country:US
Practice Address - Phone:303-783-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008270363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical