Mikah J Bange
Individual provider Active NPI Athletic Trainer · Eolia, MO
NPI 1902557796 · NPPES record last updated Jan 12, 2022
Key facts
- NPI
- 1902557796
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 30342 Pike 221
Eolia, MO 63344-4605 - Phone
- (573) 560-0567
- NPI assigned
- Jan 12, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
30342 Pike 221
Eolia, MO 63344-4605
Mailing address
30342 Pike 221
Eolia, MO 63344-4605
Phone (573) 560-0567
Other providers in Eolia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.