Active NPI
Stefanie Ann Mikulics, M.D.
- Gynecology Physician
- Templeton, CA
National Provider Identifier
1275553497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- A68329
- Practice address
- 1050 Las Tablas Rd
Suite 2
Templeton, CA 93465-9729 - Phone
- (805) 434-9441
- Fax
- (805) 434-9456
- NPI assigned
- Jul 20, 2006
- Last updated
- Apr 14, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | A68329 | CA | Primary |
Addresses
Primary practice location
1050 Las Tablas Rd
Suite 2
Templeton, CA 93465-9729
Mailing address
1050 Las Tablas Rd
Suite 2
Templeton, CA 93465-9729
Phone (805) 434-9441
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A683290 | Other | CA | BLUE SHIELD PIN |
| 00A683290 | Medicaid | CA | |
| GR0092204 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2018 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A68329 | CA | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208131200000",
"number": "1275553497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 LAS TABLAS RD",
"address_2": "SUITE 2",
"city": "TEMPLETON",
"state": "CA",
"postal_code": "934659729",
"telephone_number": "805-434-9441",
"fax_number": "805-434-9456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 LAS TABLAS RD",
"address_2": "SUITE 2",
"city": "TEMPLETON",
"state": "CA",
"postal_code": "934659729",
"telephone_number": "805-434-9441",
"fax_number": "805-434-9456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKULICS",
"first_name": "STEFANIE",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2008-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "CA",
"license": "A68329",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PIN",
"identifier": "00A683290",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A683290",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0092204",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Templeton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.