Maria Mikolaenko, DO

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

66720 Issued in CT

Practice address

2979 Main St
Bridgeport, CT 06606-4284

Phone

(203) 382-2345

Fax

(203) 366-0868

NPI assigned

May 29, 2014

Last updated

Oct 2, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1063824761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2979 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064284",
            "telephone_number": "203-382-2345",
            "fax_number": "203-366-0868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 Station Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Bellport",
            "state": "NY",
            "postal_code": "117132449",
            "country_code": "US",
            "telephone_number": "631-286-3995",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1545 9th St SW",
            "address_purpose": "LOCATION",
            "city": "Vero Beach",
            "state": "FL",
            "postal_code": "329624312",
            "country_code": "US",
            "telephone_number": "772-257-8224",
            "fax_number": "772-213-3157",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "787 37th St Ste 140",
            "address_purpose": "LOCATION",
            "city": "Vero Beach",
            "state": "FL",
            "postal_code": "32960",
            "country_code": "US",
            "telephone_number": "772-257-8224",
            "fax_number": "772-213-3157",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIKOLAENKO",
        "first_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-29",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "FL",
            "license": "OS15147",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CT",
            "license": "66720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OS15147",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meagan Migliaccio
• Emily Rachel Mihailescu, APRN
• Leona Mihalko, M.N.
• Lori Mihalov, PT
• Kimberly Mikenis
• Tyronesha T Miles, BPD
• Donna P Miller-Lewis, PMHNP
• Anne L. Miller, MS
• Aubre Ell Miller, PA-C
• Helen Lewis Miller, MD

• Adult Medicine Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Adult Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.