Active NPI
Susan Mikulec
- Physician Assistant
- Albuquerque, NM
National Provider Identifier
1083668842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2011-0042
- Practice address
- 2211 Lomas Blvd NE
Unm Neuro Diagnostics Clinic
Albuquerque, NM 87106-2719 - Phone
- (505) 272-3160
- Fax
- (505) 272-6297
- NPI assigned
- May 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601002247 | MI | |
| Physician Assistant | 363A00000X | PA2011-0042 | NM | Primary |
Addresses
Primary practice location
2211 Lomas Blvd NE
Unm Neuro Diagnostics Clinic
Albuquerque, NM 87106-2719
Mailing address
933 Bradbury Dr SE
Suite 2222
Albuquerque, NM 87106-4374
Phone (505) 272-3120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2011-0042 | NM | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1083668842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "933 BRADBURY DR SE",
"address_2": "SUITE 2222",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871064374",
"telephone_number": "505-272-3120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 LOMAS BLVD NE",
"address_2": "UNM NEURO DIAGNOSTICS CLINIC",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062719",
"telephone_number": "505-272-3160",
"fax_number": "505-272-6297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKULEC",
"first_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601002247",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "PA2011-0042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.