NPIMap

Organization Active NPI

Justin P. Mikula, M.D., Inc.

  • Internal Medicine Physician
  • Warren, OH
National Provider Identifier
1750487542
Registry record updated Jan 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35-084818 Issued in OH
Legal business name
JUSTIN P. MIKULA, M.D., INC.
Practice address
1615 N River Rd NE
Suite 1
Warren, OH 44483-2437
Phone
(330) 372-2333
Fax
(330) 373-1111
NPI assigned
Sep 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2020

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

Authorized official

Name
Dr. Justin P Mikula, M.D.NPI 1508839614
Title
President
Phone
(330) 372-2333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 35-084818 OH Primary

Addresses

Primary practice location

1615 N River Rd NE
Suite 1
Warren, OH 44483-2437

Mailing address

1615 N River Rd NE
Suite 1
Warren, OH 44483-2437
Phone (330) 372-2333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051101000650 OH Part B Supplier - Clinic/Group Practice 9436176195 Receives reassigned benefits from 3 practitioners
Practice locations: Warren, OH

National Provider Directory

National Provider Directory

Locations

913 Summit St NW
Warren, OH 44485
Phone (330) 372-2333

1615 N River Rd NE
Warren, OH 44483
Phone (330) 372-2333

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1750487542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 N RIVER RD NE",
            "address_2": "SUITE 1",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444832437",
            "telephone_number": "330-372-2333",
            "fax_number": "330-373-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 N RIVER RD NE",
            "address_2": "SUITE 1",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444832437",
            "telephone_number": "330-372-2333",
            "fax_number": "330-373-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTIN P. MIKULA, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "MIKULA",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-372-2333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-084818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.