Provider Demographics
NPI:1447361449
Name:MIKULS, MARY JANE (MD)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:MIKULS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 W DODGE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3451
Mailing Address - Country:US
Mailing Address - Phone:402-955-6877
Mailing Address - Fax:402-955-6880
Practice Address - Street 1:110 N 175TH ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3582
Practice Address - Country:US
Practice Address - Phone:402-955-5437
Practice Address - Fax:402-955-7310
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics