Charles Mikow, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

411 Issued in WI

Practice address

220 Douglas St
Chetek, WI 54728-8953

Phone

(715) 924-4811

NPI assigned

Sep 22, 2006

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 19, 2013.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376870400000",
    "number": "1679672091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021510",
            "telephone_number": "715-838-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 DOUGLAS ST",
            "city": "CHETEK",
            "state": "WI",
            "postal_code": "547288953",
            "telephone_number": "715-924-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKOW",
        "first_name": "CHARLES",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2013-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679672091",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Kohnen, RN
• Lakeview Medical Center Inc of Rice Lake
• Lakeview Medical Center Inc of Rice Lake
• Lakeview Medical Center Inc of Rice Lake
• Jeffrey M Marquardt, MD
• Diana Odagard
• Outback Chiropractic LLC
• Pharmacare LTD
• Maxwell Reisner, DDS
• Deanne Ruppel, CHC

• All providers in Chetek, WI
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; 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.