Provider Demographics
NPI:1962690982
Name:MIHALKO, GARY STEPHEN JR (IDC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEPHEN
Last Name:MIHALKO
Suffix:JR
Gender:M
Credentials:IDC
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Mailing Address - Street 1:315 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1558
Mailing Address - Country:US
Mailing Address - Phone:619-917-9380
Mailing Address - Fax:723-323-2247
Practice Address - Street 1:39 LANSDOWNE RD
Practice Address - Street 2:NAVAL BRANCH MEDICAL CLINIC
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733
Practice Address - Country:US
Practice Address - Phone:732-323-7106
Practice Address - Fax:732-323-2247
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman