Provider Demographics
NPI:1811207277
Name:MIKOLAI, JEREMY MICHAEL (ND)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:MIKOLAI
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 ADAMS ST # 350
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 HEMPSTEAD ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5638
Practice Address - Country:US
Practice Address - Phone:860-650-1030
Practice Address - Fax:855-869-4891
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1149175F00000X
CT752175F00000X
OR1784175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopath