Active NPI
Adrian George Mikulicich, MD
- Neuroradiology Physician
- San Diego, CA
National Provider Identifier
1396842993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuroradiology Physician
- License
- A21647
- Practice address
- 5575 Ruffin Rd
Ste 100
San Diego, CA 92123 - Phone
- (858) 277-2744
- Fax
- (858) 277-3085
- NPI assigned
- Sep 19, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neuroradiology Physician | 2085N0700X | A21647 | CA | Primary |
Addresses
Primary practice location
5575 Ruffin Rd
Ste 100
San Diego, CA 92123
Mailing address
PO Box 910
Rancho Santa Fe, CA 92067
Phone (858) 756-4973
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A21647 | CA | MD | Neuroradiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396842993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 910",
"city": "RANCHO SANTA FE",
"state": "CA",
"postal_code": "92067",
"telephone_number": "858-756-4973",
"fax_number": "858-756-2519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5575 RUFFIN RD",
"address_2": "STE 100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92123",
"telephone_number": "858-277-2744",
"fax_number": "858-277-3085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKULICICH",
"first_name": "ADRIAN",
"middle_name": "GEORGE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "CA",
"license": "A21647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.